Restoring Circulation to Your Carotid Artery: 2 Options

jump rope in the shape of a heart

If physicians find that you need a procedure to restore circulation to your carotid artery, here’s what you need to know.

There are two options that are currently available: 1) carotid endarterectomy, which involves work directly on the carotid artery and 2) carotid stenting, an alternative for those who may not tolerate a carotid endarterectomy.

Carotid endarterectomy

During a carotid endarterectomy, surgeons work directly on the artery to clean it out. Over the past 60 years, doctors have perfected this procedure. Today, it can be done with a single-night hospital stay. You can return to your normal activities within a week to 10 days. 

This surgery is appropriate for people:

  • Without symptoms, whose stroke risk is less than 1 percent
  • With symptoms, whose stroke risk may be slightly higher – but still less than 2 percent
  • Who have a very low risk of other complications

Here’s how the procedure works. Surgeons create a small incision in the neck.  They open the area of the artery that is affected and scrape the plaque or disease from the vessel to clean it out completely.  After cleaning out the artery, they close it with a patch of material. This makes the artery slightly bigger than it was before the procedure.  Once they complete the surgery, the patient returns to the recovery area. 

The good news is that doctors do not need to divide any significant muscle. The procedure also doesn’t cause any significant dysfunction. This targeted approach helps patients recover quickly so they can get back to regular activities. 

Carotid stenting

The second option for treating patients who have carotid artery narrowing is to use carotid stenting. Though initially investigated in the 1980s, this procedure wasn’t popularized until the 1990s. Surgeons may consider it a good alternative for patients who may not tolerate direct surgery on their carotid artery. 

Patients might require carotid stenting if they have had:

In each of these situations, the direct surgical approach to the artery is difficult. This makes stenting a reasonable alternative. 

Stenting is also considered in other situations. Patients with medical contraindications to proceeding with surgery, such as those with severe coronary artery disease and left ventricular dysfunction, may be better suited for stenting. Also, stenting is an alternative for people with severe respiratory dysfunction. 

If you have carotid artery narrowing that requires a procedure to restore circulation to your carotid artery (or what doctors may call “revascularization”), talk to your physician and your vascular specialist. Fully discuss the options to find the best method for you. 

Study compares risks of both revascularization techniques

In a recent trial, researchers studied patients with carotid artery narrowing – and compared patients with and without symptoms. The CREST trial randomized patients between carotid endarterectomy and carotid stenting and looked at the outcomes of stroke, death and heart attack over 30 days and four years. 

The outcomes of the study showed that the two treatments were similar in terms of this combined outcome.  However, if we look at the data specifically, there clearly is a higher risk of stroke in patients who have carotid stenting versus carotid surgery.  There is also clearly a higher risk of heart attack in patients who have surgery as opposed to carotid stenting.

For this reason, it is critical that you discuss with your interventionalist the specific risks related to your heart or your brain. It’s important to look carefully at both of these options to make an informed decision about treating this complex problem.

Lifestyle choices important

If you may need carotid revascularization, it is important to remember that your overall medical treatment still should take a primary role. This means that it’s important to quit smoking, control blood pressure, and control cholesterol by using statin medications as needed. Regular exercise and a good diet to improve overall health are also key. Procedures simply cannot replace these important lifestyle decisions.

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Daniel Clair, MD

Daniel Clair, MD, is Chairman of the Department of Vascular Surgery at Cleveland Clinic. In 2007, Dr. Clair was named one of America’s Top Doctors.
  • Harvey

    It’d be nice to know how an informed vegan diet compares to other diets, healthwise. In terms of animal rights it’s easy to compare.

  • TV53

    I’m sorry, but there is plenty of scientific data to back diets by Esselstyn, Ornish, and others. It must drive Dr. Esselstyn crazy to read articles like this coming from his own organization. The Pritiken center has released dozens of studies over the years, and Medicare thinks enough of the Ornish diet to now provide coverage. I guess if Esselstyn’s 20 year study, and more recent 200 person study don’t qualify as data, with their remarkable results, then I guess there’s no convincing you. Then again, you recommend a low carb diet despite the enormous volume of evidence that these diets are harmful over the long run, so it’s pretty clear that this article is not taking full account of the weight of evidence. Maybe all the local doctors who end up calling Dr. Esselstyn to help with their own heart issues might have a different opinion.

  • Ken

    Sad to see this advice with little or no reference to the impact of plant based diets on preventing and curing heart diseases, especially out of the Cleveland Clinic. Is anybody there looking at all the latest research on the impact of plant based diets on heart diseases?

  • http://www.myitnet.com Duke G

    It looks like there is a typo in this sentence:Folate and B vitamins have low risk as supplements, but there is little evidence there is improvement in PAD or lowered cardiovascular risk with these agents. They also can be harmful in patients with kidney disease. Low dose intake(400g) has been recommended for overall health.
    I doubt that 400 grams is recommended. Likely milligrams – mg.

    • The_Beating_Edge_Team

      thank you for the note! We have corrected it to (400 mcg)

  • ethel burton

    hi is there anybody out there who has a vein trapped in a curved spine that as turned to bone the vascular surgeon says he cannot remove the bone as it is too dangerous but he can put a baloon inside to open up my vein so the blood can flow better

    • The_Beating_Edge_Team

      Ethel, I spoke to Dr. Clair about your question and he stated that you should have a second opinion evaluation by a physician who sees these problems regularly. If you would like to see one of our doctors or have an online second opinion, let us know. We are happy to help you. http://www.clevelandclinic.org/heartnurse betsyRN