Carotid endarterectomy

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During carotid endarterectomy, a stenosis of the Arteria carotis communis or Arteria carotis interna is mechanically removed. Under general anesthesia, the carotid artery is opened and the stenosis is removed. The aim is to reduce the risk of stroke in patients with already symptomatic carotid stenosis.

Causes

The most common cause of carotid stenosis is atherosclerotic plaque, which grows slowly over time and becomes symptomatic once it reaches a certain point.

Diagnosis

Carotid stenosis is often diagnosed as part of a stroke workup. Various imaging modalities, such as MR angiography or CT angiography, can demonstrate carotid stenosis. The highest resolution is achieved with digital subtraction angiography. In most cases, however, the resolution of MR angiography is sufficient to establish an indication for surgery.

Conservative therapy

Asymptomatic carotid stenosis does not necessarily require surgical treatment. However, clinical studies have also demonstrated a benefit for patients with asymptomatic carotid stenosis undergoing carotid endarterectomy[^1]. Aggressive medical therapy with statins, blood pressure optimization, and dual antiplatelet therapy may likewise be considered as a treatment option for asymptomatic carotid stenosis.

Surgical treatment

Carotid endarterectomy is considered the gold standard for symptomatic carotid stenosis. Under general anesthesia, the common carotid artery and internal carotid artery are exposed. They are then clamped distally and proximally, and the vessel is opened under a microscope. The plaque responsible for the stenosis is then removed from the vessel, after which the vessel is closed with a watertight suture and the wound is closed. The procedure takes approximately 60–120 minutes.

Specific risks of the surgery

  • Intraoperative stroke: The risk is approximately 7%, depending on the study[^2]

  • Death: The risk of a fatal outcome of the surgery is approximately 1%[^2]

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Edit · Alaric Steinmetz · (+14 −14)
  • Text added: “Specific risks of the surgery”
  • Text removed: “Specific surgical risks”
  • Text changed: “Carotid endarterectomy involves the mechanical removal of a stenosis of the Common carotid artery or Internal carotid artery . Under general anesthesia, the carotid artery is opened and the stenosis is removed. The aim is to reduce the risk of stroke in patients with already symptomatic carotid stenosis.”“During carotid endarterectomy, a stenosis of the Arteria carotis communis or Arteria carotis interna is mechanically removed. Under general anesthesia, the carotid artery is opened and the stenosis is removed. The aim is to reduce the risk of stroke in patients with already symptomatic carotid stenosis.”
  • Text changed: “The most common cause of carotid stenosis is atherosclerotic plaques, which grow slowly over time and become symptomatic beyond a certain point.”“The most common cause of carotid stenosis is atherosclerotic plaque, which grows slowly over time and becomes symptomatic once it reaches a certain point.”
  • Text changed: “Carotid stenosis is often diagnosed as part of a stroke workup. Various imaging modalities, such as MR angiography or CT angiography, can visualize carotid stenosis. The highest resolution is achieved with digital subtraction angiography. In most cases, however, the resolution of MR angiography is sufficient to establish an indication for surgery.”“Carotid stenosis is often diagnosed as part of a stroke workup. Various imaging modalities, such as MR angiography or CT angiography, can demonstrate carotid stenosis. The highest resolution is achieved with digital subtraction angiography. In most cases, however, the resolution of MR angiography is sufficient to establish an indication for surgery.”
  • Text changed: “Asymptomatic carotid stenoses do not necessarily require surgical treatment. However, clinical studies also demonstrate a benefit for patients with asymptomatic carotid stenosis from carotid endarterectomy[^1]. Aggressive medical therapy with statins, blood pressure optimization, and dual antiplatelet therapy may likewise be considered as a treatment option for asymptomatic carotid stenosis.”“Asymptomatic carotid stenosis does not necessarily require surgical treatment. However, clinical studies have also demonstrated a benefit for patients with asymptomatic carotid stenosis undergoing carotid endarterectomy[^1]. Aggressive medical therapy with statins, blood pressure optimization, and dual antiplatelet therapy may likewise be considered as a treatment option for asymptomatic carotid stenosis.”
  • Text changed: “Carotid endarterectomy is considered the gold standard for symptomatic carotid stenosis. Under general anesthesia, the common carotid artery and internal carotid artery are exposed. The vessels are then clamped distally and proximally, and the artery is opened under a microscope. The plaque responsible for the stenosis is then removed from the vessel, after which the vessel is sutured watertight and the wound is closed. The procedure takes approximately 60-120 minutes.”“Carotid endarterectomy is considered the gold standard for symptomatic carotid stenosis. Under general anesthesia, the common carotid artery and internal carotid artery are exposed. They are then clamped distally and proximally, and the vessel is opened under a microscope. The plaque responsible for the stenosis is then removed from the vessel, after which the vessel is closed with a watertight suture and the wound is closed. The procedure takes approximately 60–120 minutes.”

Article created on · Alaric Steinmetz

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