Restoring Circulation to Your Carotid Artery: 2 Options

Choosing between carotid endarterectomy, carotid stenting
Restoring Circulation to Your Carotid Artery: 2 Options
Contributor: Anthony Rizzo, MD If you’ve been diagnosed with carotid artery disease, it’s important to take steps to deal with your condition. In carotid artery disease, your carotid arteries, which supply blood to the head, have narrowed due to a buildup of a waxy substance called plaque. Carotid artery disease is a serious condition for two reasons:  it can cause a stroke, in which blood flow to the brain is cut off; stroke also can occur when plaque breaks away from the artery wall. A stroke can cause lasting brain damage, long-term disability or death. Your doctor may have recommended that you make heart-healthy lifestyle changes or to take medicine to treat your carotid artery disease. But if your physician also recommends that you undergo a procedure to restore circulation to your carotid artery, there are two methods to open the narrowed or blocked carotid arteries: carotid endarterectomy and carotid artery stenting. There are important differences in the two procedures – and in outcomes, as recent research has shown. Here’s what you need to know.

Carotid endarterectomy

During a carotid endarterectomy, surgeons work directly on the artery to remove plaque. 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, who have more than an 80 percent narrowing of the artery
  • With symptoms, who have more than 50 percent narrowing of the artery
  • Who have a very low risk of other complications
Here’s how the procedure works. Surgeons create a small incision in the neck.  They expose the artery that is affected and completely remove the plaque or disease from inside the vessel to clean it out completely. Physicians then close the artery with a patch of material, which makes the artery slightly bigger than it was before. The good news is that doctors do not need to divide any significant muscle. The procedure also has a low complication rate if done by an experienced surgeon. This targeted approach helps patients recover quickly so they can get back to regular activities.

Carotid stenting

The second option is carotid stenting. Surgeons may consider it a good alternative for patients who are at high risk for a carotid endarterectomy. Patients might require carotid stenting if they have had: In each of these situations, the direct surgical approach to the artery is difficult, making stenting a reasonable alternative. Stenting also may be appropriate in other situations. For example, stenting might be a better choice for people with severe coronary artery disease, left ventricular dysfunction, or severe respiratory dysfunction.

Study compares risks of both revascularization techniques

In one study, researchers compared patients with carotid artery narrowing to patients with and without symptoms. Researchers randomized patients into two groups – one that underwent carotid endarterectomy and one that received carotid stenting – then looked at who had stroke or heart attack or died over the next 30 days and four years. The study showed that the two treatments were similar in terms of this combined outcome.  However, the data also showed there clearly was s a higher risk of stroke for patients who had carotid stenting rather than carotid surgery.  Patients who had surgery also had a higher risk of heart attack as those who had 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 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 taking statin medicine and aspirin as your physician directs. Regular exercise and a good diet to improve overall health also are key. Procedures simply cannot replace these important lifestyle decisions.

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