Carotid endarterectomy(CEA): Basic procedure and variations

Carotid endarterectomy(CEA)is the gold standard of surgical treatment for symptomatic or asymptomatic carotid stenosis. Mastering the CEA procedure is important for neurosurgeons because they gain the skill to extract plaque when it is vulnerable or high in volume in particular. In this article, we describe the basic procedure of CEA and its variations. When we perform CEA, it is important to keep a bloodless surgical field, peel off the internal carotid artery enough to expose an area distal to the plaque and extract the plaque stump surely. As variations of CEA, we describe emergent CEA, CEA for radiation induced carotid stenosis and hybrid operations. In all cases, we must perform the procedure with rigorous care to avoid perioperative complications.