Carotid Stenosis Health Article

Treatment team

Diagnosis and treatment of carotid stenosis involves the primary care physician, nurses, neurologist, neurosurgeons, neuroradiologists, and specialists who are skilled in performing angioplasty.

Treatment

Carotid stenosis is treated surgically or medically. One of two surgical treatments is typically used. The first approach is known as microsurgical carotid endarterectomy. The second approach is termed endovascular angioplasty and stenting.

Carotid endarterectomy is the surgical exposure of the carotid artery and the removal of the plaque. This re-establishes the uninterrupted flow of blood to the brain. This approach is the method of choice for most patients. However, the technique does itself carry a risk of stroke (stroke can be caused in up to 3% of surgeries).

For patients who are unable to undergo surgery, the angioplasty and stenting approach is used. In this approach a catheter that contains an expandable region at one end is inserted into the carotid artery. The end of the catheter is then expanded. This "balloon" squeezes the plaque against the arterial wall, increasing the effective diameter of the artery. Then, a stent is placed inside the artery. A stent is a tubular arrangement of fibers somewhat similar visually to wire fencing rolled up into a tube. The stent reinforces the carotid artery to prevent its collapse and to keep the plaque tightly against the arterial wall.

Surgery and the associated risks may not be warranted in patients whose arterial blockage is less than 50%. Anticoagulant medications such as aspirin can be used instead to reduce the tendency of blood clots to form. Treatment can also consist of lifestyle modifications such as stopping smoking, limiting cholesterol intake, or use of cholesterol-lowering medications.

Clinical trials

As of February 2004, a clinical trial designed to investigate the relative effectiveness of carotid angioplasty with stenting versus carotid endarterectomy in preventing stroke, myocardial infarction, and death was recruiting patients in the United States and Canada. Participants should have symptoms of carotid stenosis. The trial, called "Carotid Revascularization Endarterectomy versus Stent Trial (CREST)," was being coordinated by the National Institute for Neurological Diseases and Stroke.

Another clinical trial was designed to examine the role of diet (specifically high doses of vitamin E) on the metabolism of low-density lipoprotein, which is critical in plaque formation. This trial was being coordinated by the National Institute of Health's National Center for Complimentary and Alternative Medicine. Information on both clinical trials may be found at the National Institute of Health Clinical Trials website: www.clinicaltrials.gov.

Prognosis

With prompt medical treatment, including surgery, recovery from carotid stenosis can be complete with no residual effects. However, if treatment is delayed or if a stroke occurs, damage can be permanent.

If carotid stenosis is dealt with promptly by surgery, medicine, or lifestyle modifications, prognosis is good. For example, at the Johns Hopkins Medical School, carotid stenosis corrective surgery has a mortality rate of 0.8% (80 in 1,000 people) and a morbidity rate (the person survives, but with some complication) of 1.8% (18 in 1,000 people).

However, undiagnosed stenosis can result in stroke. Depending on the severity of the stroke, prognosis is variable. An estimated 325,000 strokes and 75,000 deaths occur each year in the United States due to carotid stenosis.

Special concerns

Even if there are no symptoms associated with the presence of carotid stenosis, the malady is often a warning sign of possible blockage of the arteries of the heart, or coronary artery disease. Thus, people diagnosed with carotid stenosis should be carefully monitored for coronary artery disease.

BOOKS

Wiebers, David. Stroke-Free for Life: The Complete Guide to Stroke Prevention and Treatment. 2nd. ed. Mayo Clinic. New York: Harper Resource, 2002.

PERIODICALS

Biller, J., and W. H. Thies. "When to operate in carotid artery disease." American Family Physician (January 2000): 400–406.

OTHER

Johns Hopkins Department of Neurosurgery. "What is Carotid Stenosis?" Johns Hopkins University School of Medicine. (February 1, 2004). <http://www.neuro.jhmi.edu/cerebro/cs.html>.

"Risk Reduction through Surgery: Carotid Endarterectomy." National Stroke Association. (March 1, 2004). <http://209.107.44.93/NationalStroke/StrokePrevention/Risk+Reduction+through+Surgery.htm>.

Toronto Brain Vascular Malformation Study Group. "Carotid Stenosis. What is Carotid Stenosis?" University of Toronto. (February 1, 2004).<http://brainavm.uhnres.utoronto.ca/malformations/content/carotid_stenosis.htm>.

ORGANIZATIONS

American Stroke Association, a division of the American Heart Association. 7272 Greenville Avenue, Dallas, TX 75231. (888) 4-STROKE. <http://www.strokeassociation.org>.

Centers for Disease Control and Prevention (CDC). 1600 Clifton Road, Atlanta, GA 30333. (404) 639-3311 or (800) 311-3435. <http://www.cdc.gov>.

National Institute for Neurological Diseases and Stroke (NINDS). 6001 Executive Boulevard, Bethesda, MD 20892. (301) 496-5751 or (800) 352-9424. <http://www.ninds.nih.gov>.

Brian Douglas Hoyle, PhD