Carotid endarterectomy (CEA) is a surgical procedure used to treat plaque buildup (atherosclerosis) in the carotid arteries, which run up the neck and supply oxygen-rich blood to the brain. During surgery, the plaque is stripped away from the inner lining of a carotid artery, increasing blood flow to the brain. As a result of the procedure, there is a lowered risk of stroke.

Patient selection for carotid endarterectomy has historically presented a challenge for physicians. On the one hand, the procedure has been shown to reduce risk of stroke among certain patients. However, this benefit has to be balanced against the risk of complications, especially the possibility of a stroke occurring as a result of the surgery. Also, there has been significant disagreement about the benefit of carotid endarterectomy in patients who are not experiencing symptoms related to their condition (e.g., they are asymptomatic).

A number of large clinical trials have been conducted over the past 15 years as research groups attempt to identify the best patient groups for this procedure. In 2005, the American Academy of Neurology (ANN) looked at results of these trials and issued the following guidelines:

• Carotid endarterectomy shows significant benefit for patients with symptomatic disease and a 70 percent to 99 percent blockage of their carotid arteries.
  
  
• A lesser benefit was found for symptomatic patients with 50 percent to 69 percent blockage, but there was still a benefit.
  
  
• Data is mixed for patients with asymptomatic disease, but in general, there is a benefit for patients with 60 percent to 99 percent blockage, providing there is a low rate of complications during the surgery itself.
  
  
• Carotid endarterectomy is not recommended for patients with less than 50 percent blockage.

It is important to note, however, that these are only general guidelines. Every individual case is different, and many other factors may affect the decision to recommend carotid endarterectomy. Such factors include age, gender, overall health and concomitant, or additional, health concerns, such as the presence of coronary artery disease. Finally, the success of this procedure is closely associated with the experience of the surgeon performing the operation.

Patients scheduled for surgery should prepare for a two-day stay in the hospital. They can expect an aching feeling in their neck after surgery, which should be gone within two weeks.