• Treatment Options for Carotid Artery Disease

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    You might not need surgery if you have carotid artery disease. SecondsCount Editor-in-Chief Dr. J. P. Reilly, of Ochsner Medical Center in New Orleans, LA, explains how stents are used to increase the flow of blood to the brain.

    For the last 50 years, a diagnosis of narrowing, or stenosis, in the carotid arteries would most likely result in a recommendation of surgery to prevent stroke. Surgery to remove plaque from the carotid arteries, called a carotid endarterectomy, is still a viable and life-saving procedure that is performed today. However, now more than ever, physicians have latitude to assess the degree of narrowing in the arteries, the age of the patient, and other factors to determine the best course of treatment. Your physician may recommend any of the following:

    Medication and lifestyle changes. A central part of treating carotid artery disease is managing causes of the disease through medications and lifestyle changes. Doing so may be enough to control your carotid artery disease. In other cases, your doctor may prescribe medication and lifestyle changes along with surgery or a procedure such as carotid angioplasty and stenting. Commonly prescribed medications include statins to reduce cholesterol, blood thinners (anticoagulants) to reduce the risk of clotting, and medications to control high blood pressure.

    Carotid endarterectomy. This effective surgical procedure has been the standard in stroke prevention for decades. During a carotid endarterectomy, the surgeon, as part of the patient's overall care team, makes an incision in the patient's neck directly at the point of the blockage of the carotid artery. The surgeon then removes the plaque that is forming the blockage. Carotid endarterectomy is indicated for a wide range of patients but research indicates that it seems to be particularly effective for those who are over age 69.

    Carotid angioplasty and stenting. Many of the lessons learned in treating heart disease have been applied to treating vascular disease throughout the body, including the carotid arteries. Since the 1990s, there has been increasing excitement about the potential to apply angioplasty and stenting to the treatment of carotid artery disease. Research suggests that carotid angioplasty and stenting have outcomes comparable to carotid endarterectomy and may have particular benefits for patients who are age 69 and under.

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    This short animation shows how a carotid angioplasty and stenting procedure can open blocked arteries in the neck and restore blood flow to the brain, potentially preventing a stroke.

    Angioplasty is a procedure in which a thin tube called a catheter is inserted into an artery, usually near the groin, and threaded up to the carotid arteries in the neck where the blockage is. A small balloon is inflated to push the plaque to the sides of the artery wall and expand the artery. When the balloon opens, plaque and other debris may break free. This debris is caught by a tiny umbrella-like device (called a distal protection device) at the end of the catheter to greatly reduce the risk of stroke during the procedure. Then the physician will often place a stent, a tiny mesh tube, in the artery to help keep it open. Watch the video animation here to see how a carotid angioplasty and stenting procedure works.

    For more on stroke treatment, click here.