Carotid Endarterectomy - Contraindications

Contraindications

The procedure cannot be performed in case of:

• Complete internal carotid artery obstruction (because there is no benefit to treating chronic occlusion).
• Previous stroke on the ipsilateral side with heavy sequelae, because there is no benefit in preventing what has already happened, or risking making it worse.
• Patient deemed unfit for the operation by the surgeon or anesthesiologist.

High risk criteria for CEA include the following:

• Age ≥80 years.
• Class III/IV congestive heart failure.
• Class III/IV angina pectoris.
• Left main or multi vessel coronary artery disease.
• Need for open heart surgery within 30 days.
• Left ventricular ejection fraction of ≤30%.
• Recent (≤30-day) heart attack.
• Severe lung disease or COPD.
• Severe renal disease.
• High cervical (C2) or intrathoracic lesion.
• Prior radical neck surgery or radiation therapy.
• Contralateral carotid artery occlusion.
• Prior ipsilateral CEA.
• Contralateral laryngeal nerve injury.
• Tracheostoma.