Carotid endarterectomy—Surgical nuances

Abstract

Carotid endarterectomy (CEA) is a crucial surgical intervention developed to prevent cerebrovascular accidents
in patients with significant carotid artery stenosis/narrowing. This procedure involves the removal of plaques
from the intimal surface of the carotid artery to restore adequate cerebral perfusion and reduce the risk of
embolic events. As one of the most common vascular surgeries, CEA requires strict adherence to surgical
protocols to minimize complications and ensure favorable patient outcomes. Typically performed under general
anesthesia, CEA necessitates precise anatomical visualization and careful dissection of the common, internal,
and external carotid arteries. This article provides an in-depth review of surgical considerations, including patient
positioning, arterial clamping, plaque removal, arterial closure techniques, and intraoperative shunting based on
neuromonitoring feedback. In addition, it outlines essential postoperative care to monitor and address potential
complications, aiming to offer neurosurgeons a comprehensive guide to achieving optimal outcomes in CEA.