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Treatment of Carotid Stenosis
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.
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
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.