Carotid Endarterectomy

What Is Carotid Stenosis?

Carotid stenosis is frequently called carotid artery disease. When the two major arteries that carry oxygen-rich blood from the heart to the brain narrow due to buildup of fatty deposits called plaque this is called atherosclerosis.  The narrowing reduces blood flow to the brain, which is called stenosis.

If blood flow is reduced for a period of time a transient ischemic attack (TIA) may occur.  If the blood flow is blocked a stroke may occur. The treatment called a carotid endarterectomy removes the plaque buildup and prevents blood clots.

Many people have no symptoms until the artery becomes severely narrowed or a clot forms. Symptoms are most likely to first appear as a mini-stroke, called a transient ischemic attack or a TIA.  Symptoms of a TIA can include weakness or numbness in an arm or leg, difficulty speaking, a drooping face, vision problems, or paralysis affecting one side of the body, you should call 911 if this occurs.

Atherosclerosis begins with damage to the inner wall of the artery caused by high blood pressure, diabetes, smoking, and high cholesterol –specifically “bad” cholesterol or low-density lipoprotein (LDL). Other risk factors include obesity, coronary artery disease, a family history of carotid stenosis, and advanced age.

Older people are most likely to be affected, before age 75, men are more likely at risk than women.


Treatment For Carotid Stenosis

Surgical treatment is generally recommended for patients who have suffered one or more TIAs or strokes and who have a moderate to high grade of carotid stenosis.  The aim of surgery is to prevent stroke by removing or reducing the plaque buildup and enlarging the artery to allow more blood flow to the brain.

  • Carotid endarterectomy – A skin incision is made in the neck and the carotid artery is located. Temporary clamps are placed across the artery above and below the area of stenosis to stop blood flow. During this time, the carotid artery on the other side of the neck carries blood flow to the brain. The surgeon makes an incision in the artery over the blocked area. The plaque buildup is physically peeled out and removed. The artery is then closed with tiny sutures and the clamps removed to allow blood flow to the brain.
  • Carotid angioplasty / stenting – This a minimally invasive endovascular procedure that compresses the plaque and widens the artery. It is performed during an angiogram. A flexible catheter is advanced from the femoral artery in the groin, past the heart, and to the location of the plaque within the carotid artery. Next, a small catheter with an inflatable balloon at the tip is positioned across the plaque. When the balloon is opened, it dilates the artery and compresses the plaque against the arterial wall. The balloon is then deflated and removed. Finally, a self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery.
  • Carotid artery bypass – This surgical procedure reroutes the blood supply around the plaque-blocked area. A length of artery or vein is harvested from somewhere else in the body, usually the saphenous vein in the leg or the ulnar or radial arteries in the arm. The vessel graft is connected above and below the blockage so that blood flow is rerouted (bypassed) through the graft. Bypass is typically only used when the carotid is 100% blocked (carotid occlusion).