In which situations do most strokes associated with CEA occur?

The majority of strokes associated with carotid endarterectomy (CEA) occur after the cross-clamping is released due to several physiological changes that take place at this stage of the procedure. During the operation, the common carotid artery is often clamped to prevent blood flow during the removal of atherosclerotic plaques. When the clamp is removed, there is a sudden surge of blood flow to the brain, which can dislodge any small debris or thrombi that may have formed during surgery or that were existing in the artery. This release of clamping can also result in changes in hemodynamic stability and cerebral perfusion, increasing the risk of embolic strokes. Additionally, this phase is critical as it represents the moment when potential complications from the procedure become more pronounced, hence the heightened incidence of stroke during this period. Understanding these mechanisms is essential for monitoring and mitigating risks during and following a CEA.