Carotid Artery Disease is the narrowing of the carotid arteries. Carotid artery disease can be treated medically, interventionally or surgically.
Once the doctor confirms that you have carotid artery disease, the treatment will depend on the degree of narrowing and if you are having symptoms.
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 1½ 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.
How to choose the right treatment
The surgeon or vascular specialist must look at the patient's medical history and test results; and weigh the benefits and risks of each approach. Treatment must be tailored to the individual patient.
Whether medication, surgery or an intervention is the treatment choice, all three must be accompanied by lifestyle changes. These include quitting smoking, eating a healthy diet, and regular exercise.
If you have carotid artery disease, choose a center that has experience and all options for treatment to give you the best chance of a successful outcome.
Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.
Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.
Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons
Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:
Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.
Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.
IVC Filter Retrieval Clinic - to make an appointment, call Vascular Medicine at 216.444.4420. Ask for Dr. Bartholomew in the Filter Retrieval Clinic. Your appointment will include a consultation with Dr. Bartholomew and the physicians who will perform the IVC filter retrieval procedure.
You may also use our MyConsult second opinion consultation using the Internet.
The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:
Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.
If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
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