Frequently Asked Questions
Video by Daniel Clair, M.D.
Chairman of the Department of Vascular Surgery
Specialties: Carotid artery surgery, thoraco-abdominal aortic repair/reconstruction, thoracic aortic aneurysm repair, abdominal aortic aneurysm repair, peripheral artery/vein repair/bypass surgery, aortic aneurysm stent repair, endovascular stent repair.
Hello. I am Dr. Daniel Clair. I’m the chairman of the Department of Vascular Surgery at Cleveland Clinic. I’d like to talk with you today about carotid artery disease and its treatment options.
The carotid arteries are what you feel when you check your pulse at the front of your neck. They supply blood to the front part of the brain, which controls thinking, speech, personality and motor function. When those arteries are narrowed by a build up of fat and cholesterol, blood flow to the brain decreases. This is called carotid artery disease, and it can lead to a stroke if not treated.
Currently, there are two treatment methods available for carotid artery disease. The first is a surgical procedure that has been around since the 1950s and has a long history of success. It is called carotid endarterectomy. In this surgery, your doctor will make a small incision in the carotid artery and remove the plaque buildup. The incision is then closed. With this procedure, which has been more thoroughly studied than any other surgical procedure, recovery is quick, scarring is minimal and the risk of complications is low.
A newer procedure is carotid stenting. In this procedure a stent, which is a small mesh tube, is inserted through the groin and directed to where the blockage is. Once in position, the stent is expanded. It essentially pushes the plaque out of the way and provides a sort of scaffolding to hold the artery open and to increase blood flow.
Carotid stenting has only been used for about 10 years, but the risks and benefits have proven to be very similar to those of carotid endarterectomy.
While normally carotid stenting is thought of as minimally invasive, both procedures – carotid endarterectomy and carotid stenting – have a short recovery time, and patients can generally return to normal activities after a week or so. Both are well-tolerated and most patients experience a little pain following either procedure. Rarely do patients need more than over-the-counter pain relievers.
The surgical technique and the stenting procedure are similar in success and risk, but there are some differences. Because we are experienced in both procedures, we can choose an appropriate treatment on a patient-by-patient basis. Some people, because of their health history, are better suited for one procedure than the other. By educating patients about the different procedures, we can help empower individuals to decide how to proceed with the treatment of the disease.
At Cleveland Clinic, we have a long history of good outcomes with both procedures. Though stenting is relatively new, we were one of the first facilities with experience in the procedure and have had great success. We have been performing carotid endarterectomy for decades and are national and international leaders in the field. Your doctor can help determine your risk and discuss your options with you.
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