What are the treatment options for carotid artery stenosis?

Dr. Ketan N. Desai, DO
Cardiologist (Heart Specialist)

The carotid arteries are the blood vessels that carry blood up to the brain. When you feel the pulse in your neck, you are actually feeling blood flow through the carotid arteries. When there is a severe blockage within the carotid arteries, there is a high risk for sustaining a stroke. There are two primary treatment options for carotid artery stenosis. The first is an open surgical technique called carotid endarterectomy. With this surgery, the blockage is removed from the artery. Recovery time is usually short. The second option has more traditionally been reserved for patients in whom their medical conditions make the surgery a higher risk and a less invasive approach called carotid artery stenting may be more appropriate. This procedure is performed from the leg where a catheter is placed from the leg up to the carotid artery area in the neck. Through the catheter, a stent is placed across the narrowing in the carotid artery to reopen the blood vessel.

Patients whose blockages are mild to moderate can often manage their disease by making lifestyle changes such as quitting smoking and by working with their doctors to take care of related conditions such as diabetes, high blood pressure, and high cholesterol. Doctors will monitor the disease and initiate other treatments if the disease begins to progress. They may also prescribe blood-thinning drugs or other medications.

Minimally invasive procedure

  • Carotid Stenting: In some cases doctors may place a stent, a small mesh support tube, at the site of the blockage in the carotid artery.
  • MERCI Retriever: The MERCI Retriever is a tiny corkscrew-like device that is threaded through the circulatory system through a puncture of the artery of the leg and guided to the arteries of the brain to ensnare and remove a clot.

Traditional surgery

  • Carotid Endarterectomy: The standard method of treating disease in the carotid artery is via an operation called carotid endarterectomy. During this procedure, which is performed under general anesthesia, surgeons clamp one of the diseased carotid arteries to stop blood from flowing through it, make an incision into the blocked section of the artery, and remove the plaque deposit.
Dr. Frank R. Arko, MD
Vascular Surgeon

There are three current options of therapy for carotid artery stenosis but this depends on the degree of stenosis and whether or not you are having any symptoms. The first treatment option would be antiplatelet therapy (Aspirin or Plavix), which most patients should be taking if there are no contraindications. Secondly, intervention either with a stent or surgery is indicated for high degree stenosis without symptoms of 70 percent or greater depending on your overall medical condition. If you are having symptoms then intervention is recommended for 50 percent stenosis.

Sometimes a stent can be placed to open the blocked area and restore blood flow. In more severe cases, surgery may be required to clear the blockage. Medical management with cholesterol-lowering drugs called statins is always a part of treatment.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.