Carotid Artery Stenosis: Understanding Treatment Options

Carotid artery stenosis, or the narrowing of the carotid arteries, requires tailored treatment depending on its severity. Mild cases can often be managed effectively with medication, while more advanced or symptomatic narrowing typically necessitates surgical or interventional procedures such as carotid endarterectomy or carotid angioplasty with stenting.

When Is Medication Sufficient?

For patients without symptoms and with less than 50% narrowing of the artery, medication is often the first line of treatment. This may include antiplatelet drugs like aspirin to reduce the risk of blood clots. Regular monitoring through imaging tests is also recommended to track any progression of the condition.

When Surgery or Intervention Becomes Necessary

If the narrowing exceeds 50% and is accompanied by symptoms such as transient ischemic attacks (TIAs) or minor strokes, revascularization procedures are usually advised. In cases where the stenosis exceeds 70%, treatment is strongly recommended regardless of whether symptoms are present. The primary goal of these interventions is to remove plaque buildup, restore normal blood flow, and prevent stroke by reducing the risk of clot formation and embolism.

Carotid Endarterectomy: A Proven Surgical Option

Carotid endarterectomy is a well-established surgical procedure for treating carotid artery stenosis. During the operation, a surgeon makes a 10–15 cm incision along the neck to access the affected artery. After temporarily clamping the artery above and below the narrowed segment, the surgeon opens the vessel and carefully removes the plaque from the inner lining. The artery is then closed, often with a patch to widen the vessel and improve blood flow. The procedure typically lasts 2–3 hours, and most patients can return to normal activities within 1–2 days after surgery.

Carotid Artery Stenting: A Minimally Invasive Alternative

Carotid angioplasty and stenting is a less invasive option, especially for patients who may be at higher risk for surgery. Under local anesthesia, a catheter equipped with a small balloon and a specialized filter device—often referred to as an "embolic protection device"—is guided to the site of the narrowing. The balloon is inflated to widen the artery, and a custom-designed metal stent is placed to maintain the newly opened passage. In some cases, a second balloon may be used to ensure optimal stent expansion. Because the procedure is performed under local anesthesia, patients remain awake and comfortable during the treatment.

Choosing the Right Treatment Path

Deciding between surgical and interventional treatments depends on several factors, including the patient's overall health, the degree of stenosis, and whether symptoms are present. Consulting with a vascular specialist or neurologist is crucial in determining the most effective and safest approach to managing carotid artery disease and reducing the risk of stroke.