Carotid Endarterectomy (CEA) and Carotid Stenting
Patients with symptoms of a stroke or TIA are usually evaluated for blocked
arteries in the neck (atherosclerotic lesions in the carotid arteries). If these blockages are at least 50-70% blocked,
then an intervention may be necessary. Even in patients without symptoms, blockages of more than 80% are usually
treated.
Current treatment options are optimal medical therapy plus:
1. Surgery, known as carotid endarterectomy (CEA) or
2. Carotid artery stenting (CAS)
The surgical procedure (CEA) has been performed for many years, and involves
an incision on one side of the neck. The artery is temporarily bypassed, cut open, and the cholesterol plaque is removed.
Surgery is more effective than medication alone in preventing stroke, as long as the performing surgeon has a low complication
rate. In general, this is a safe procedure with a good success rate. However, there are risks, such as myocardial
infarction (heart attack), stroke, damage to the cranial nerves and death. Also, in a minority of patients, the
blockage can re-form at the surgery site (restenosis).
Some patients are considered to be at high risk for complications from carotid
artery surgery, due to the fact that they have other co-existing illnesses, such as heart or lung disease or have had
previous surgery or radiation therapy to the neck. An alternative procedure is carotid artery stenting (CAS). This procedure
is minimally invasive and does not involve a neck incision. It consists of placing a stent in the affected carotid artery
to relieve the blockage. CAS is generally safe, but strokes can also occur with this procedure.
In general, the best course of action is decided only after a careful review
of the different treatment modalities and individual risks by the treating physician in conjunction with the patient.
Clinical trials are ongoing in evaluating the best treatment, and you may be eligible for such a clinical trial.
