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Treatment of Carotid Stenosis

 

Medication


For a patient with <50% occluded artery medication may be prescribed to try and prevent a thromboembolic event (a blood clot to the brain). Medication such as aspirin, and plavix interfere with platelet function that is involved in blood clotting. Other medication are anticoagulants and these interfere with with the formation of a blood clot. Heparin and coumadin are examples.



 

Carotid Endarterectomy


This is a surgical procedure done by a neurosurgeon. This may be recommended for patients with severe symptomatic stenosis of >70% of the vessel. Under a general anesthetic the neurosurgeon exposes and opens the carotid artery. Meticulous removal of the plaque and precise closure of the vessel with a microsurgical technique. 
Several prospective studies have shown a reduction in the long-term risk of stroke after endarterectomy in patients with severe stenosis



 

Carotid Angioplasty and Stenting


Currently this treatment remains experimental. This is used as an alternative treatment for high-risk surgical patients.

This is done in an interventional angiographic suite under local anesthesia at the puncture site and minimal conscious sedation.

A small puncture is made in the femoral artery at the groin. From this site, small catheters are fed up to the carotid artery. A predilation of the carotid artery may be needed prior to stent placement. This involves advancing a guidewire across the stenosis and then an angioplasty balloon is placed across the lesion. The balloon is inflated to widen the artery. The next step is the placement of the stent. This stent is threaded up to the narrowed artery from the groin. The stent is expanded, opening the narrowed artery. Another dilation of the stent may be required once the stent is in place.


(picture shows a stent)