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.