Carotid Endarterectomy
Mansi Arora, MD
Issue 3 | Volume 2 | August 2026
A Clinical Overview
Carotid endarterectomy (CEA), i.e., the surgical removal of atherosclerotic plaque from the internal carotid artery, is one of the most commonly performed vascular procedures and remains the gold-standard surgical treatment for selected patients with significant carotid artery stenosis at elevated risk of ischemic stroke. Landmark trials: including the North American Symptomatic Carotid Endarterectomy Trial (NASCET), the Asymptomatic Carotid Atherosclerosis Study (ACAS), and the Asymptomatic Carotid Surgery Trial (ACST-1) have firmly established its efficacy, cementing CEA as a cornerstone of stroke prevention in appropriately selected patients.
Anesthetic Considerations
From an anesthetic perspective, CEA presents challenges that extend well beyond routine perioperative care. It operates at the intersection of cerebrovascular physiology, significant cardiac comorbidity, and intraoperative neurological monitoring, all demanding a thorough understanding of cerebral autoregulation, hemodynamic targets, and real-time decision-making during critical phases of the surgery. The brief window of intentional cerebral ischemia during cross-clamping represents one of the most physiologically consequential moments in vascular anesthesia, requiring continuous vigilance and structured, evidence-based management.
About This PBLD
This Problem-Based Learning Discussion (PBLD) uses a structured clinical case to guide a learner-driven, interactive exploration of the perioperative anesthetic management of CEA. Topics include anesthetic technique selection (regional versus general anesthesia), neuromonitoring modalities, intraoperative hemodynamic management, shunting indications, emergence considerations, and recognition of procedure-specific postoperative complications — including cerebral hyperperfusion syndrome and cranial nerve injury. Summary tables and key hemodynamic targets are included as structured reference tools, designed to be immediately applicable in the operating room and to serve as a concise resource throughout anesthesia residency training
