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Treatments and drugs
By Mayo Clinic staff
The goal in treating carotid artery disease is preventing stroke. The method of treatment depends on how narrow your arteries have become.
Mild to moderate blockage
When you have mild to moderate blockage of your arteries, the following recommendations may be sufficient to prevent stroke:
- Make lifestyle changes. Healthy changes in your behavior can help reduce the stress on your arteries and slow the progression of atherosclerosis. Such changes include quitting smoking, losing weight, eating healthy foods, reducing the amount of salt you eat and exercising regularly.
- Manage chronic conditions. It's also key to manage any chronic conditions you have, such as high blood pressure, excess weight or diabetes. With your doctor, you can form a plan to specifically address these conditions by managing your blood pressure, maintaining a healthy weight, controlling your blood sugar levels and lowering your cholesterol.
- Use medications. Your doctor may ask you to take a daily aspirin or another blood-thinning medicine to avoid the formation of dangerous blood clots. He or she may also recommend medications to control your blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers, or a statin medication to lower your cholesterol.
Severe blockage
When you have severe blockage of your arteries — especially if you've already had a TIA or stroke related to the blockage — it's best to open up the artery and remove the blockage. There are two ways to do this:
- Carotid endarterectomy. This surgical procedure is the most common treatment for severe carotid artery disease. The procedure is done under either local or general anesthesia. After making an incision along the front of your neck, your surgeon opens the affected carotid artery and removes the plaques. The artery is repaired with either stitches or, preferably, a graft. Studies have also shown that the surgery is low risk in most otherwise healthy people, has lasting benefit and helps prevent strokes.
- Carotid angioplasty and stenting. A carotid endarterectomy isn't recommended when the location of the narrowing or blockage is too difficult for the surgeon to access directly or when you have other health conditions that make surgery too risky. In such cases, your doctor may recommend a procedure called carotid angioplasty and stenting. While you're under local anesthesia, a tiny balloon is threaded by catheter to the area where your carotid artery is clogged. The balloon is inflated to widen the artery, and a small wire mesh coil called a stent is inserted to keep the artery from narrowing again.
References
- Carotid artery disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/catd/catd_whatis.html. Accessed June 24, 2011.
- Carotid artery disease, stroke, transient ischemic attacks (TIAs). Society for Vascular Surgery. http://www.vascularweb.org/vascularhealth/Pages/carotid-artery-disease-,-stroke-,-transient-ischemic-attacks-(-tias-)-.aspx. Accessed June 24, 2011.
- Feldman G, et al. Peripheral arterial disease. In: Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0986-5..C2009-0-38984-9--TOP&isbn=978-1-4377-0986-5&about=true&uniqId=236797353-5. Accessed June 25, 2011.
- Schwartz J, et al. Cardiovascular disease in the elderly. In: Bonow RO, et al. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0398-6..C2009-0-59734-6--TOP&isbn=978-1-4377-0398-6&about=true&uniqId=236798031-10. Accessed June 25, 2011.
- Furie KL, et al. Evaluation of carotid artery stenosis. http://www.uptodate.com/home/index.html. Accessed June 24, 2011.
- Questions and answers about carotid endarterectomy. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/stroke/carotid_endarterectomy_backgrounder.htm. Accessed June 24, 2011.
- FDA expands approved use for carotid stent. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm254430.htm. Accessed June 24, 2011.
- Angioplasty and vascular stenting. Radiological Society of North America. http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty. Accessed June 24, 2011.
- Healthy diet goals. American Heart Association. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp. Accessed June 28, 2011.
- Meissner I (expert opinion). Mayo Clinic, Rochester, Minn. July 6, 2011.
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