Carotid Endarterectomy
Carotid endarterectomy is a vascular surgical procedure in which the atherosclerotic plaque built up on the inner surface of the carotid artery in the neck is surgically removed. It is performed to reduce the risk of stroke and transient ischemic attack caused by carotid stenosis.
Përditësimi i fundit: 2026-06-09
Definition
Carotid endarterectomy is a surgical method in which the atherosclerotic plaque that has developed in the internal carotid artery supplying blood to the brain is removed by opening the vessel. During the procedure the artery is temporarily controlled, the plaque causing the narrowing and the associated damaged inner layer are cleared, and the vessel is then closed with sutures or a patch. The aim is to improve blood flow through the narrowed artery and to prevent clot fragments arising from the plaque from traveling to the brain. It is a long-established technique with an extensive body of clinical evidence in the surgical treatment of carotid stenosis.
Indications
Carotid endarterectomy is considered in patients with significant carotid stenosis demonstrated on imaging (Doppler ultrasound, CT or MR angiography). The strongest indication is in patients who have had a transient ischemic attack or stroke attributable to the stenosis on the same side (symptomatic) and who have reached a defined degree of narrowing; NASCET and similar trials defined the benefit in this group. In asymptomatic high-grade stenosis the decision is individualized according to the patient's general condition, life expectancy, and surgical risk. Assessment considers the degree of stenosis, plaque characteristics, and the patient's comorbidities together.
Procedure
The procedure is performed under general or regional anesthesia with the patient supine and the head turned slightly to the side. An incision is made along the carotid artery in the neck to expose and control the common, internal, and external carotid arteries. Before the vessel is opened it is clamped; a temporary shunt may be placed when needed to maintain cerebral blood flow. The artery is opened longitudinally, the plaque is carefully peeled away together with the inner layer, and the arterial wall is smoothed. The vessel is closed directly or with a patch, the clamps are released, and flow is checked; neurological monitoring methods may be used throughout the procedure.
Advantages and Limitations
Carotid endarterectomy is a method with long clinical experience, supported by randomized trials showing reduced stroke risk in symptomatic high-grade stenosis, and it allows direct removal of the plaque. Compared with carotid stenting, an alternative, each option has its own advantages and risks in particular patient groups; the choice of method varies with age, vascular anatomy, and comorbidities. Surgery may be limited when the neck anatomy is unfavorable, in very high-lying stenoses, or in patients with severe comorbid disease. Surgery is not required for all stenoses; some cases are managed with medical therapy.
Recovery and Risks
Patients are usually kept under close observation for a short period after the procedure, with monitoring of blood pressure and neurological status. Possible risks include stroke during or after the procedure, bleeding and neck hematoma, wound infection, transient or permanent effects on nearby nerves (for example changes in voice or swallowing), and recurrence of the narrowing over time. Although it is a procedure intended to reduce stroke risk, no outcome is guaranteed; the decision is individualized by considering the patient's clinical status, imaging findings, alternative treatments, and expectations together.
Burimet
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1545-1559.
- Spetzler RF, Kalani MYS, Nakaji P, eds. Neurovascular Surgery. 2nd ed. Thieme; 2015.
- North American Symptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991.
- Kleindorfer DO, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack. AHA/ASA. Stroke. 2021.
Ky artikull ka karakter të përgjithshëm informues dhe nuk zëvendëson vizitën mjekësore. Vendimet për diagnozën dhe trajtimin janë individuale.