There have been many studies regarding stroke prevention and control of carotid disease. Routine follow-up of carotid disease with carotid ultrasound, MRA or CTA will indicate if the disease is stable or if it is progressing.
Until the degree of blockage has progressed to around 70%, the condition is treated medically. Carotid disease is initially treated with antiplatelet agents such as aspirin or clopidogrel. Blood pressure control and dietary control of fats and sugars are important in slowing the progression of carotid disease.
When the patient has symptoms of transient ischemic attack (TIA, also known as “mini stroke”) or stroke, the treatment changes to intervention. The rationale for treatment is to prevent future strokes. Any stroke that has already occurred will not be improved by surgery.
The NASCET (North American Symptomatic Carotid Endarterectomy Trial) demonstrated that in patients with symptoms and blockage of more than 60%, that overall outcomes were generally better with surgery than with optimal medical treatment.
A carotid endarterectomy is a surgical procedure where the blocked lining of the carotid artery is dissected off the vessel and removed. The surgery can be done with general anesthesia or with a nerve block and local anesthesia.
The artery itself and the incision in the neck are closed with sutures. Usually the patient is in the hospital overnight.
Recovery is rapid and normal activities can begin when the patient feels up to it. Any pre-surgery stroke symptoms will require rehabilitation.
An alternative to carotid endarterectomy in some patients is carotid angioplasty and stenting. This procedure can often be performed under intravenous (IV) sedation rather than general anesthesia.
In a carotid angioplasty, an angiogram is performed and a balloon is advanced across the blockage in the carotid artery. The balloon is inflated and the blockage is pushed back into the wall of the artery. Then a nitinol stent is advanced over the area and opened up to keep the blockage from reoccurring.
A basket called a distal protection device is placed beyond the area to be treated. Any debris such as pieces of plaque are caught in the basket and removed after the procedure is completed.
Patients typically stay in the hospital overnight and resume their normal activities quickly. As with carotid endarterectomy, carotid angioplasty and stenting is done to prevent future strokes.
The patient will need to be on multiple antiplatelet agents for at least 3 months and aspirin is usually continued for life.
Many centers are doing clinical trials to determine if carotid endarterectomy or carotid angioplasty/stenting is preferred in a given patient population. This data is still evolving.
Dr. Ahuja performs both of these procedures from his offices in southeastern Wisconsin, and he will recommend the procedure that is best for your individual situation. He has been involved in these trials and has the most current information available regarding the advantages and disadvantages of both procedures.