What is the risk of complications from carotid endarterectomy (CEA)?

Updated: Oct 24, 2019
  • Author: Sonia Nhieu, MD; Chief Editor: Sheela Pai Cole, MD  more...
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CEA is indicated for symptomatic 70-99% carotid stenosis and is three times as effective as medical therapy alone in reducing the incidence of stroke. [2]  In cases of moderate (50-69%) carotid stenosis, the benefit is less clear, and the patient's risk factors for stroke must be weighed against the risk of perioperative complications in deciding between operative and medical therapy. Patients with lower-grade (< 50%) carotid stenosis do not benefit from surgical treatment. [3, 4, 5]

Whereas the overall risk of perioperative stroke and death for patients undergoing CEA is 6.5%, the risk of a permanently disabling stroke and death is lower, at 2%. [6]  For the benefits of surgical therapy to outweigh those of medical therapy, the post-CEA complication rate must be less than 3%. [7, 2]  In addition to perioperative stroke, serious complications that may develop after CEA include myocardial ischemia and infarction, hemodynamic instability, cranial nerve (CN) injuries, and bleeding resulting in neck hematomas and airway compromise. [8]

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