Carotid endarterectomy

Carotid endarterectomy (CEA) is the most commonly performed procedure to prevent stroke, with approximately 99,000 operations performed nationally in 2006. Over the last decade, carotid artery stenting (CAS) has emerged as a minimally invasive alternative to CEA. Recent results from the CREST trial suggest that stroke and death occur less frequently with CEA; however, myocardial infarction occurs more frequently with CEA. While CEA remains the gold-standard therapy, many interventionalists continue to reserve CAS for “high-risk” patients, as defined by anatomic and/or medical criteria. Usual postoperative course Expected postoperative hospital stay Since complications from either procedure typically occur within the first 12–24 hours, patients are usually discharged within the first 1–2 days following the operation. Operative mortality Mortality following CAS or CEA is less than 1%, and is mostly due to complications of stroke or myocardial infarction. Special monitoring required Patients in the post-anesthesia care unit are monitored with an arterial line for a period of 2–4 hours to assess for wide fluctuations in blood pressure. Ideally, the patient’s postoperative blood pressure should be similar to the preoperative blood pressure. If medications are required to maintain a patient’s blood pressure, he/she is then transferred to the ICU for 24 hour monitoring and appropriate anti-hypertensive or vasopressor medication administration.