Surgical Treatment Options
Carotid Endarterectomy (CEA)
Carotid endarterectomy is the most commonly performed surgical treatment for carotid artery disease. During carotid endarterectomy, the surgeon reduces the risk of stroke from the operation by shunting (using a plastic tube to re-route blood flow to the brain) and monitoring the patient carefully. While the patient is under general anesthesia, an incision is made in the neck, at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and repairs the diseased portion of the artery. Then, blood flow to the brain is restored through its normal path. The procedure normally takes approximately 1 Â½ to 2 hours and is extremely well-tolerated by most patients.
Recovery from carotid endarterectomy is rapid, as most patients are discharged home the day after the carotid artery disease surgical treatment procedure. While the operation can result in some post-operative neck pain, most of this can be relieved with standard, over-the-counter pain medications, such as extra strength Tylenol.
Carotid Angioplasty and Carotid Stenting
For patients who meet certain eligibility criteria, carotid stenting offers an alternative approach to repairing the blockage in the artery. Carotid stenting is approved as a carotid artery disease surgical treatment for patients who are experiencing symptoms, have a carotid artery that is blocked 70 percent or more, and for whom surgery would be high risk. Some examples of patients who might benefit from this approach as opposed to carotid endarterectomy include patients who have had prior surgery or radiation surgery in the neck.
Angioplasty and stenting is usually performed using a local anesthetic and include the use of uniquely designed devices that can limit debris from traveling to the brain while the procedure is being performed. These devices, called cerebral protection devices, have been extensively studied at the Cleveland Clinic. In angioplasty, a balloon catheter is guided to the area of the blockage or narrowing. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls to improve blood flow. A medication such as heparin may be given during the procedure to reduce the risk of blood clots.
During the angioplasty procedure, a carotid stent (a small, metal mesh tube) is placed inside the carotid artery at the site of the blockage and provides support to keep the artery open. The stent stays in place permanently and acts as a scaffold to support the artery and keep it open. After several weeks, the artery heals around the stent.
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