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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:
- In mild to moderate cases, lifestyle changes and medications may be sufficient to prevent stroke.
- If blockage is severe or if you've already had a TIA or stroke, surgery or a stenting procedure may be necessary.
Lifestyle changes
Quitting smoking, losing weight, eating healthy foods and exercising regularly are important steps in reducing the stress on your arteries and slowing the progression of atherosclerosis. Lowering the sodium content of your food also may help.
It's also key to manage any chronic conditions you may have, as prescribed by your doctor. If you have high blood pressure, it's important that you stay at or under your blood pressure goal. Similarly, it's important to control your blood sugar levels if you have diabetes, or lower your cholesterol if you have high cholesterol levels.
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.
Procedures
If narrowing in a carotid artery is severe, and especially if you've already experienced a TIA or stroke, 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 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. Because the procedure is relatively new, its durability and long-term ability to prevent stroke are still under investigation.
- Lee JT, et al. Peripheral arterial disease. In: Rakel RE, et al. Conn's Current Therapy 2008. 60th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/151488178-7/866918859/1621/197.html#4-u1.0-B978-1-4160-4435-2..50101-1_1467. Accessed July 23, 2009.
- Riles TS, et al. Cerebrovascular disease. In: Townsend CM, et al. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/151488178-3/866914256/1565/622.html#4-u1.0-B978-1-4160-3675-3..50068-X--cesec4_3762. Accessed July 23, 2009.
- Schwartz JB, et al. Vascular disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007.http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-4106-1..50078-9--cesec28&uniq=151488178&isbn=978-1-4160-4106-1&sid=866915121#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4160-4106-1..50078-9--cesec95%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4160-4106-1. Accessed July 23, 2009.
- Carotid artery disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/catd/catd_whatis.html. Accessed July 23, 2009.
- Carotid artery disease, stroke, transient ischemic attacks (TIAs). Society for Vascular Surgery. http://www.vascularweb.org/patients/NorthPoint/Carotid_Artery_Disease.html. Accessed July 23, 2009.
- Furie KL, et al. Secondary prevention of stroke: Risk factor reduction. http://www.uptodate.com/home/index.html. Accessed July 23, 2009.
- Angioplasty and vascular stenting. Radiological Society of North America. http://www.radiologyinfo.org/en/info.cfm?pg=angioplasty. Accessed Aug. 28, 2009.
- 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 Aug. 12, 2009.
- Greelish JP, et al. Carotid angioplasty and stenting. http://www.uptodate.com/home/index.html. Accessed July 23, 2009.
- Greelish JP, et al. Carotid endarterectomy: Preoperative evaluation; surgical technique; and complications. http://www.uptodate.com/home/index.html. Accessed July 23, 2009.
- Sodium. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=4708. Accessed July 23, 2009.
- Stop smoking: Resources and tools for quitting. American Heart Association. http://www.americanheart.org/presenter.jhtml?identifier=3038010. Accessed July 23, 2009.
- Rundek T, et al. Risk factor management to prevent first stroke. Neurologic Clinics.2008;26:1007.
