Restoring Circulation to Your Carotid Artery: 2 Options

Choosing between carotid endarterectomy, carotid stenting

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.

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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. 

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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. 

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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.


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.