What are the indications for endarterectomy?
Indications
- Ipsilateral TIA and carotid artery stenosis exceeding 70%, combined with required coronary artery bypass grafting (CABG)
- Progressive stroke and carotid artery stenosis exceeding 70%
What is the primary indication for carotid endarterectomy?
A carotid endarterectomy may be needed if one or both of your carotid arteries become narrowed because of a build-up of fatty deposits (plaque). This is known as carotid artery disease or carotid artery stenosis, and it significantly increases your risk of having a stroke or transient ischaemic attack (TIA).
What is an endarterectomy and when is this procedure performed?
Carotid endarterectomy (CEA) is surgery to treat carotid artery disease. The carotid arteries are the main blood vessels that carry oxygen and blood to the brain. In carotid artery disease, these arteries become narrowed. This reduces blood flow to the brain and could cause a stroke.
What is a femoral endarterectomy?
A femoral endarterectomy (say “FEM-uh-rull en-dar-tuh-REK-tuh-mee”) is done to remove fatty buildup (plaque) from the femoral artery. This is a large blood vessel in the leg. When plaque builds up in the artery, it can make it hard for blood to flow in your leg. After surgery, blood may flow better in your leg.
When is CEA performed?
For patients with symptomatic carotid occlusion (50-99%), CEA must be performed shortly after the onset of symptoms to be beneficial. If CEA is performed within 2 weeks of symptom onset, the number needed to treat for preventing one stroke is 5 and is recommended.
Who is a candidate for carotid endarterectomy?
In conclusion, patients with mild to moderate intracranial disease and severe symptomatic extracranial stenosis are ideal candidates for carotid endarterectomy. For those with moderate stenosis and IAD, endarterectomy is recommended, but for those without IAD, endarterectomy is unlikely to be beneficial.
Who performs endarterectomy?
Vascular surgeons perform carotid endarterectomy to remove plaque from the carotid arteries and lower your stroke risk.
Why is a carotid endarterectomy contraindicated in 100% occlusion?
Contraindications. The procedure is not necessary when: There is 100% internal carotid artery obstruction because there is an increased risk of stroke and cerebral damage instead of the surgery reducing the risk.
Is endarterectomy a major surgery?
The procedure A carotid endarterectomy usually takes 1 to 2 hours to perform. If both of your carotid arteries need to be unblocked, 2 separate procedures will be carried out. One side will be done first and the second side will be done a few weeks later.
What can I expect after an endarterectomy?
Your Recovery You can expect the incision to be sore for about a week. The area around it may also be swollen and bruised at first. The area in front of the incision may be numb. This usually gets better after 6 to 12 months.
Is CEA considered high risk surgery?
Patients considered a surgical high risk can undergo CEA without any worse outcome compared with those patients deemed low risk. The benefit of CAS will likely be marginal, and only controlled clinical trials will be able to determine if certain subgroups demonstrate improved outcome with CAS.
Which group of patients would most benefit from carotid endarterectomy?
Within this group, carotid endarterectomy is most beneficial for the following patients: otherwise healthy elderly patients, those with hemispheric transient ischemic attack, those with tandem extracranial and intracranial lesions and those without evidence of collateral vessels.
What is the degree of stenosis for endarterectomy?
This important study forms the basis of current practice guidelines: patients with 50% or more stenosis of the carotid artery and history of ipsilateral stroke or TIA are recommended to have carotid endarterectomy.
Is femoral endarterectomy an inpatient procedure?
The surgical procedure can be performed under general or local anaesthetic. The plaque is removed from the artery. A patch is often used to repair the artery and avoid narrowing. Patient’s will stay in hospital 1 or 2 nights following this procedure.
How risky is an endarterectomy?
The 2 main risks are: stroke – the risk of stroke is around 2%, although this may be higher in people who have had a stroke before the operation. death – there’s a less than 1% risk of death, which can occur as a result of complications such as a stroke or heart attack.