The surgical removal of the material inside the arteries at the front of the neck that provide blood to the brain is called a carotid endarterectomy (CEA). This procedure can be performed with the patient awake (local anesthesia) or asleep (general anesthesia). Precautions are usually taken to ensure adequate blood flow to the brain during the operation and may include; the monitoring of brain waves (EEG), keeping the patient awake for repeated examinations, monitoring 'back pressure' in the clamped artery, or placing a diverting tube to allow continued blood flow to the brain (shunt). Each method is acceptable, and choice should be determined based upon the surgeon, the patient, and the facility at which the operation is performed. The patient has an incision in the front of the neck along where the artery lies

 

The benefit of CEA has been established in two major United States trials in the last 15 years. These trails were established because of the belief by many doctors that aspirin and drugs were superior in the prevention of stroke to surgical operation. These beliefs were put to the test in a randomized, prospective, blinded, multi-center trails (this represents the best form of medical evidence) in both the United States and Europe. The studies results in Europe and the United States had similar findings, in that surgery significantly reduced the risk of stroke compared to medication therapy in certain instances. The risk of stroke and death in three years on medication for a patient having symptoms from the involved carotid artery was 22%, and only 12.3% if surgery was performed (about half that of medication alone). When the carotid artery was blocked by more than 60% even if not causing the patient any problems, the risk of stroke in five years with medications was 11%, and only about 5% with surgery.