Vascular

Carotid Endarterectomy

CAROTID ENDARTERECTOMY (CEA)

Indication: Symptomatic internal carotid artery stenosis ≥50–70% (transient ischaemic attack or stroke in the preceding 6 months). Asymptomatic stenosis ≥60–80% in selected good-risk patients. Reduces the risk of stroke by approximately two-thirds in symptomatic patients with significant stenosis. Morbidity and mortality <2% in experienced hands.

Patient Position: Supine, head on ring, slightly extended and turned away from the operative side.

Anaesthesia: General or regional (cervical block). Intra-operative monitoring: neurological assessment (awake patient with cervical block allows direct assessment), EEG, transcranial Doppler, or stump pressure measurement used to determine need for shunt.

Prophylactic Antibiotics: Per protocol.

Incision: Longitudinal incision anterior to the sternocleidomastoid (SCM) muscle along the anterior border.

Procedure:
1. SCM retracted posteriorly. Carotid sheath opened. Common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA) dissected and controlled with slings.
2. Hypoglossal nerve identified and preserved.