ABSTRACT
Cerebral protection and monitoring during the carotid endarterectomy (CEA) are critical to prevent stroke due to lack of collateral circulation to the brain. Indeed, it is imperative that the shunt be placed properly to avoid risk of embolic stroke, air embolus, or dissection. However, a hemorrhagic stroke warrants reversal of any anticoagulation and may require discussion with neurosurgery. Bleeding after CEA is an important complication to avoid as large neck hematomas can result in airway compromise and death. Luckily, significant bleeding is rare due to meticulous evaluation of the operative field prior to closure. Postoperative bleeding is reported to occur in under 3.0% of cases. A valsava maneuver can be given by the anesthesia team to test the anastomosis. If significant bleeding is identified during these maneuvers, it should be treated with ligation, suture, or electrocautery. Some surgeons prefer to place a drain prior to closing the incision to monitor bleeding.
