Carotid endarterectomy, also called carotid endarterectomy, or CEA for short, is a surgical procedure performed to prevent ischemic stroke. The key significance of CEA is to improve the blood supply to the patient’s brain and prevent ischemic strokes. Most of the blood to the brain is supplied by the carotid artery. On both sides of the neck, the pulsations of the carotid artery can be very clearly palpated. When atherosclerosis occurs in the carotid arteries, the atheromatous plaque can narrow or even occlude the lumen, resulting in inadequate blood supply to the brain; alternatively, the atheromatous plaque may rupture and shed debris that enters the brain with the blood flow, which then blocks smaller vessels. In both cases, ischemic stroke can occur. In patients whose atherosclerosis has caused severe narrowing of the carotid arteries, CEA to remove the atheromatous plaque and recanalize the carotid arteries can greatly reduce the likelihood of subsequent strokes. Clinical manifestations Symptoms of cerebral ischemia: tinnitus, blurred vision, dizziness, headache, memory loss, drowsiness or insomnia, and excessive dreaming. Transient ischemic attack (TIA) may also occur, and in severe cases, episodic syncope or even hemiparesis may occur. If combined with subclavian artery theft will aggravate the symptoms of cerebral ischemia Plaque or thrombus dislodgement can lead to TIA and cerebral infarction. Commonly seen in atherosclerotic occlusive carotid artery stenosis Multiple aortitis in the active phase may have symptoms such as general malaise, fever, easy fatigue, loss of appetite, weight loss, excessive sweating, and menstrual irregularities How to detect carotid artery stenosis There are two conditions in which carotid artery stenosis is detected. The first condition is found by chance during a routine physical examination, where the doctor will auscultate the neck and if a murmur is heard, it suggests the possible presence of carotid stenosis. Since the patient does not have any symptoms at this time, we call it asymptomatic stenosis. In the other case, the stenosis is detected by imaging after a transient ischemic attack (TIA) or a mini-stroke, which is called symptomatic stenosis.
When carotid stenosis is detected, the degree of stenosis must be determined and the treatment must be based on the degree of stenosis. There are usually four tests that can be used to perform a carotid artery examination: transcranial Doppler ultrasound, CT angiography (CTA), magnetic resonance angiography (MRA), and intravascular catheter angiography (DSA). The first three methods are non-invasive, while the last method requires a thin catheter to be inserted into the artery, injected with a contrast agent and then viewed under X-ray. The doctor will decide which method is most appropriate on a case-by-case basis. Numerous studies have demonstrated that in patients with symptomatic stenoses of more than 50%, CEA is more effective than medical therapy in preventing ischemic stroke; and the higher the stenosis, the more effective the procedure is. Patients with asymptomatic stenosis may also benefit from CEA if the stenosis is very severe; however, in patients with moderate or mild asymptomatic stenosis and mild symptomatic stenosis, the disadvantages of CEA outweigh the benefits and patients should receive medical therapy such as antihypertensive, lipid-lowering, and antiplatelet therapy. Indications for surgery Absolute indications: (1) 1 or more TIAs within 6 months, manifested by significant limited neurological deficits or unilateral blindness within 24 hours and carotid stenosis ≥ 70%; (2) 1 or more mild non-disabling strokes within 6 months, with signs or symptoms lasting longer than 24 hours and carotid stenosis ≥ 70%. Relative indications: (1) asymptomatic carotid stenosis ≥ 70%; (2) symptomatic or asymptomatic carotid stenosis.