Treatment of Carotid Artery Disease is essential to reduce the risk of stroke.
The treatment depends on the symptoms, the severity of carotid narrowing, the carotid plaque characteristics and your overall physical condition.
It can be lifestyle changes with medical treatment, open surgical repair (carotid endarterectomy) or minimally invasive endovascular repair (carotid stenting).
All three options have a place in contemporary practice and your vascular surgeon will guide you towards the best option.
Treatment is individualized for every patient, taking into account all the aforementioned factors. As a general rule, carotid narrowing less than 50% is only treated medically, irrespective of symptoms.
Manifestation of symptoms (transient ischemic attack or stroke) and carotid narrowing more than 50% requires intervention as there is a high risk for a subsequent ischemic event.
For patients without symptoms but with a high grade stenosis more than 70%, who are active, with a good life expectancy and a low medical risk, intervention is also recommended to prevent a future stroke.
Some scientists currently argue that medical treatment alone may be sufficient for these asymptomatic patients irrespective of the severity of carotid stenosis.
The type of intervention (carotid endarterectomy vs carotid stenting) is another topic of debate, however carotid endarterectomy seems to be safer for symptomatic patients.
A thorough discussion with your vascular surgeon, understanding the risk and alternatives and taking into account your personal opinion will guide the final decision.
Lifestyle Changes and Medical Treatment
Lifestyle changes and appropriate medical treatment is the cornerstone of treatment of Carotid Artery Disease, irrespective of the decision to intervene or not.
Your doctor will monitor and control your blood pressure and your cholesterol levels with appropriate medication (anti-hypertensives and lipid lowering agents/statins).
You will also be asked to start a baby aspirin (or clopidogrel). If you smoke, you should obtain help to stop smoking. A healthy diet and living with regular physical exercise is also recommended.
Carotid Artery Disease will not "go away" by itself; however appropriate medical treatment can slow or even cease its progression and the anticipated risk of stroke.
It is extremely important to continue to follow up with your vascular surgeon as directed because the carotid disease may progress.
There is no need for physical activities or work restrictions provided that these remain within reasonable limits.
Carotid Endarterectomy
Carotid endarterectomy is the most commonly performed surgical treatment for carotid artery disease.
While the patient is under general anesthesia, an small incision is made in the neck at the location of the blockage.
The surgeon isolates and opens the carotid artery to remove the atherosclerotic plaque. Then, the artery is sewn back together to allow improved blood flow to the brain.
Typically patients who undergo this procedure have a supervised hospital stay for one day after surgery.
While the operation can result in some post-operative neck pain, most of this can be relieved with standard pain medications.
As with any operation, carotid endarterectomy has a risk of minor and major complications, the most serious one being the risk of stroke.
You will want to discuss them thoroughly with your vascular surgeon.
Carotid Artery Stenting
Carotid stenting is a procedure that is one done without a neck incision. The procedure is performed through a groin puncture.
With the use of X-ray guidance and special endovascular wires and catheters guided through the vascular lumen, a stent (metallic mesh tube) is inserted via the femoral artery and advanced up into the carotid artery to the site of the blockage, where it is expanded.
Typically patients who undergo this procedure have a supervised hospital stay for one day after surgery.
As with any operation, carotid stenting has a risk of minor and major complications, the most serious one being the risk of stroke.
You will want to discuss these thoroughly with your vascular surgeon.
