Is Surgery the Best Treatment for Carotid Artery Disease?

A fellow caregiver asked...

How do we decide if surgery is the best option for carotid artery disease?

Expert Answer

Jeremy Payne, M.D., is the medical director of Banner Good Samaritan Stroke Center in Phoenix, Arizona.

Your best bet is probably to use the same criteria most doctors use. For starters, we look at just how badly the artery is blocked. If the artery is more than 80 percent blocked, surgery may be the best option. However, there are many other factors to look at. The procedure itself is risky -- it can cause a stroke -- so this isn't something we do unless we have to.

Many people have narrowing of the carotid artery but are asymptomatic. I've seen patients whose arteries were 95 percent narrowed who didn't know they had a problem. If someone isn't experiencing symptoms, we're much less likely to consider surgery. If I have a healthy 85-year-old with 80 percent narrowing of the carotid artery, I want to take a really good look at whether he's noticed any problems. Some people have had a transient ischemic attack (TIA) but don't realize it; all they know is that they felt funny for a little while and then recovered. So I ask my patients a lot of questions: Have you ever experienced any numbness? Has there ever been a time when your speech was impaired? That kind of thing.

The next thing to look at is whether the patient is a good operative risk. Age, general health, weakness, other conditions all have to be taken into consideration. The risk of surgery causing a stroke is upwards of 5 percent, so we weigh that against the risk of the arterial blockage causing a stroke.

Often the best idea is to take steps to lower someone's stroke risk, then do a repeat test in six months. We'll have the patient stop smoking, take a statin, and we'll lower their blood pressure aggressively. We'll use daily aspirin to thin the blood. In six months, if the test shows the artery is slowly closing more, then we need to do the procedure.

If you do opt for surgery, you should know that there are two types of surgery available. Traditional surgery is a procedure called a carotid endarterectomy, which involves making an incision in the neck and removing the plaque from the artery. It requires a one- to two-day hospital stay.

Sometimes we can perform a balloon stent angioplasty instead. That's a less invasive procedure where we go in through the groin, using a catheter. However, this is still a risky procedure and involves a one-day hospital stay. Doctors decide who's a candidate for a stent angioplasty based on the location, size, and shape of the blockage in the artery.