Carotid Artery Procedures After a Stroke or TIA

Topic Overview

When is a carotid artery procedure an option?

You have two carotid arteries, one on each side of your neck. They carry blood to your brain. Narrowing (stenosis) in a carotid artery increases your risk of stroke. If you have had a stroke or transient ischemic attack (TIA), your doctor may suggest that you have a carotid artery procedure to help lower your risk of a stroke.

There are two types of carotid artery procedures: carotid endarterectomy surgery and carotid artery stenting. Endarterectomy is more common than stenting.

Your doctor will check several things to see if a procedure is an option for you. These things include:

• The amount of narrowing in your carotid arteries. A procedure may be an option if the narrowing is more than 50%.
• Whether you had a stroke or TIA within the past 6 months.
• Whether you have a low risk (less than 6%) of dying or having a stroke from a procedure.

A doctor may give you the option of having a procedure, but this may not be not a clear-cut decision. How you feel about the risks and benefits is just as important as the medical facts.

How are these procedures done?

Carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is surgery to remove plaque buildup from a carotid artery. During this surgery, a surgeon:

• Makes a cut in the neck just below the jaw.
• Opens the carotid artery and carefully removes the plaque.
• Closes the artery and skin incisions with stitches.

Carotid artery stenting is also called carotid angioplasty. It is similar to coronary angioplasty, which is done to open narrowed or blocked arteries in the heart. During this procedure, a doctor:

• Threads a tube through an artery in the groin or arm and passes it up to the carotid artery.
• Inflates a tiny balloon to enlarge the narrowed portion of the artery.
• Places a small, expandable tube called a stent to keep the artery open.

How well do carotid artery procedures work?

• In people who have already had a TIA or stroke and who have 50% to 99% narrowing of the carotid arteries, carotid endarterectomy reduces the risk of TIA and stroke.^{footnote 1}
• Carotid artery stenting may work as well as endarterectomy to prevent stroke in some people who have narrowed carotid arteries.^{footnote 2}
• Endarterectomy is usually safer than stenting for people older than 70. For people in this age group, the risk of stroke or death from stenting is too high.^{footnote 3}

Timing is important in how well these procedures work. People may benefit most from a procedure if it is done within 2 weeks of the stroke or TIA. This is when the risk of another stroke is highest.

What are the risks of carotid artery procedures?

The risks of carotid endarterectomy include:

• Infection.
• Breathing problems.
• Nerve damage that could cause serious problems, like trouble swallowing.
• Stroke, heart attack, or death.

The risks of carotid stenting include:

• Infection.
• Bleeding at the catheter insertion site.
• Damage to the blood vessel at the catheter insertion site.
• Stroke, heart attack, or death.

Your chance of having a serious problem depends on things like your age and your overall health. Your doctor can help you understand your risk of problems from a procedure. It is important that your risk of stroke or death is less than 6%.^{footnote 4} It is also important to find a surgeon and a hospital that have experience in doing the procedure and have a low rate of serious problems..

Who should not have a carotid artery procedure?

A carotid procedure is not advised for some people. For example, a procedure may not be an option if you have:

• Severe coronary artery disease.
• Severe disease of the arteries that branch off from the carotid arteries.
• Other serious medical problems, such as kidney failure or heart failure. These can make a procedure more risky.

Are there other ways to reduce the risk of another stroke?

Taking medicines and making healthy lifestyle changes are very important in preventing another stroke. These steps help control the conditions that increase your risk of stroke.

Having a procedure does not take the place of these steps. If you decide to have a procedure, you will still need to take medicine and have healthy habits.

Medicines that can help reduce the risk of stroke include:

• Aspirin or other blood thinners. They help prevent blood clots.
• Blood pressure medicines. These help prevent the damage to blood vessels that can cause plaque to build up.
• Statins, which help lower cholesterol.

Healthy habits that can help reduce the risk of stroke include:

• Not smoking.
• Eating heart-healthy foods.
• Being active. Your doctor can tell you what amount and type of activity is right for you.
• Staying at a healthy weight or losing weight if you need to.