Carotid Endarterectomy in Sarasota

Carotid endarterectomy (CEA) is a surgical procedure that removes plaque buildup from the carotid arteries in the neck to prevent stroke. At Sarasota Vascular Specialists, our board-certified vascular surgeons perform CEA for patients with significant carotid artery stenosis, following American Heart Association and American Stroke Association guidelines for stroke prevention.

Carotid endarterectomy is the gold-standard surgical treatment for carotid artery disease. During the procedure, a vascular surgeon makes a small incision in the neck, opens the affected carotid artery, and carefully removes the atherosclerotic plaque that has narrowed the vessel. By restoring normal blood flow to the brain, CEA significantly reduces the risk of stroke. According to the AHA/ASA, CEA reduces stroke risk by up to 65% in symptomatic patients with 70-99% carotid stenosis.

Symptomatic Carotid Stenosis

Patients who have experienced a transient ischemic attack (TIA or “mini-stroke”), amaurosis fugax (temporary vision loss), or stroke within the past 6 months and have 50-99% carotid stenosis are strong candidates for CEA. The AHA/ASA recommends CEA within 2 weeks of symptom onset for optimal stroke prevention benefit.

Asymptomatic Carotid Stenosis

Patients without symptoms who have 60-99% carotid stenosis may benefit from CEA when performed by a surgeon with a perioperative stroke/death rate below 3%. The decision accounts for patient age, medical comorbidities, life expectancy, and stenosis progression rate.

• CEA — Lower periprocedural stroke rate; preferred for patients over 70; proven long-term durability
• CAS — Lower cranial nerve injury risk; preferred for patients with prior neck radiation, high surgical risk, or recurrent stenosis after prior CEA

Our carotid disease specialists evaluate each patient individually to determine whether CEA or CAS offers the best stroke prevention with the lowest risk.

Before Surgery

Pre-operative evaluation includes carotid duplex ultrasound, CT angiography (CTA) or MR angiography (MRA), cardiac risk assessment, and review of current medications. Blood thinners may be adjusted prior to surgery.

During Surgery

CEA is performed under general or regional (cervical block) anesthesia. The surgeon makes a 3-4 inch incision along the neck, clamps the carotid artery, opens it, and removes the plaque. A temporary shunt may be used to maintain brain blood flow during the procedure. The artery is then closed, often with a patch to prevent restenosis. Total operative time is approximately 2-3 hours.

After Surgery

Most patients spend one night in the hospital for neurological monitoring. Blood pressure is closely controlled in the first 24 hours. Patients typically resume normal activities within 1-2 weeks and return to driving within 2 weeks, pending surgeon clearance.

CEA is one of the most studied procedures in vascular surgery. At high-volume centers like Sarasota Vascular Specialists, the combined stroke and death rate for CEA is well below the 3% threshold recommended by the AHA/ASA for asymptomatic patients. Other potential risks include:

• Cranial nerve injury (temporary in most cases)
• Wound hematoma
• Restenosis (5-10% at 5 years)
• Myocardial infarction

Carotid artery disease often develops silently. The AHA recommends screening for patients with:

• History of TIA or stroke
• Carotid bruit detected on physical exam
• Significant atherosclerosis in other arteries (coronary, peripheral)
• Age over 65 with multiple cardiovascular risk factors

Screening involves a painless carotid duplex ultrasound that takes approximately 30 minutes. No preparation is required.

Learn more about carotid artery disease management at SVS, or meet our vascular surgery team.