Carotid Artery Disease
Carotid artery disease is a form of atherosclerosis, or a build-up of plaque in one or both of the main arteries of the neck. The carotid arteries are vital as they feed oxygen-rich blood to the brain. When plaque builds up in the carotid arteries, they begin to narrow and slow down blood flow, potentially causing a stroke if blood flow stops or plaque fragments travel to the brain.
Every year, 15 million people worldwide suffer a stroke, also known as a brain attack. Nearly 6 million die and another 5 million are left permanently disabled. Carotid artery disease is estimated to be the source of stroke in up to a third of cases, with 427,000 new diagnoses of the disease made every year in the United States alone.
Carotid artery disease is typically silent and does not present with symptoms. Physicians can screen patients based on risk factors like high blood pressure, diabetes, obesity and smoking. Sometimes, patients are screened for carotid artery disease if the doctor knows the patient has vascular disease elsewhere in the body. Blockages can also be found when a physician hears a sound through a stethoscope placed on the neck. The sound is caused by blood flowing past the blockage.
If someone is having stroke-like symptoms (weakness/numbness on one side, loss of eyesight/speech, garbled speech, dizziness or fainting), they should seek immediate medical attention.
Treatment options
Leaders in carotid revascularization
Our surgeons specialize in both open surgical repair (carotid endarterectomy) and transcarotid stenting (TCAR) to treat carotid stenosis.
Carotid Endarterectomy (CEA) is open surgical procedure removes plaque from inside the carotid artery in order to restore normal blood flow to the brain. The surgeon makes an incision on the neck to access the affected artery, opens the artery and removes the plaque. The surgeon will then close the artery and the incision in the neck using stitches.
TransCarotid Artery Revascularization (TCAR) is a hybrid procedure that was developed to treat patients with carotid artery disease who are at risk for open surgery. The entire TCAR procedure is performed through a smaller incision in the neck and in less than half the time of a carotid endarterectomy – limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure. During the TCAR procedure, a tube inserted into the carotid artery is connected to a system that temporarily directs blood flow away from the brain to protect against dangerous debris from reaching the brain and causing a stroke during the procedure. A stent is implanted to the carotid artery to stabilize plaque and help prevent future strokes.
Over 10,000 procedures have been performed worldwide through clinical trial and commercial use. TCAR has been studied extensively, and the clinical data have been excellent.
A small incision is made at the base of the neck, just above the collarbone. A puncture is made into the carotid artery and a small tube is placed inside the artery, which is connected to the system that temporarily directs blood flow away from the brain and captures any dangerous debris that dislodges from the artery. The blood is then filtered and returned to a vein through a second tube placed in the groin. While the brain is protected during this temporary flow reversal, a stent is placed in the carotid artery to stabilize the plaque and is intended to help prevent against future stroke. The blood flow is then returned to normal and the system is removed.
The entire procedure usually takes less than an hour. Patients can be either asleep or awake during the TCAR procedure and patients are typically held overnight for observation.