Barnes-Jewish & Washington University Heart & Vascular Center offers advanced techniques to treat carotid artery disease and prevent strokes. Our surgeons are committed to the best treatment methods, high success in surgical outcomes, and leading vascular research both nationally and internationally. As one of the largest vascular surgery programs in the nation, our surgeons perform more than 200 carotid procedures each year. Our vascular surgeons are active participants in clinical trials as well as the Society for Vascular Surgery-sponsored Vascular Registry.
Understanding Carotid Artery Disease
The carotid arteries are the main source of blood flow to the brain and face. The carotid arteries are located on each side of the neck and extend from the aorta in the chest to enter the base of the skull into the brain. A healthy artery is open and allows the blood to flow to the brain. Blood flow can become partially or totally blocked by fatty material called plaque. As more plaque forms, the artery becomes narrower and the walls become irregular, which can cause blood clots to form on the plaque.
A partial blockage of the artery is called carotid artery stenosis (narrowing). Blockage in the carotid artery can reduce the blood supply to the brain and lead to a stroke. A stroke can also be caused by plaque which breaks loose and travels to the brain (embolization). If a small blood vessel is blocked, this causes a mini-stroke (transient ischemic attack, or TIA). A TIA is often a warning sign that a stroke may soon occur and should prompt seeking medical attention.
As the degree of narrowing increases, so do the risks of stroke and embolization. Patients with high blood pressure, diabetes and high cholesterol are at risk, as are patients who are overweight or smoke.
Symptoms of carotid artery disease include weakness, numbness, paralysis, slurred speech or vision problems.
Diagnosing and Treating Carotid Artery Disease
To evaluate your carotid arteries, the doctor may order one or more of the following:
- ultrasound, which uses painless sound waves to measure the thickness of the carotid arteries and how fast blood flows through the arteries. Our vascular laboratory is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL) and performs a tremendous number of carotid ultrasounds annually.
- angiography, in which a dye is injected into the arteries as X-rays are taken
- computed tomographic angiography (CTA), which images carotid arteries and can show evidence of prior stroke
- magnetic resonance angiography (MRA), which uses magnetic fields to image carotid arteries and can show evidence of prior stroke
Not all patients need surgery right away. Treatment for carotid stenosis is needed in patients who have had a prior stroke, prior TIA, or severely blocked carotid arteries. Once the diagnosis of significant carotid stenosis is made, the most appropriate therapy is vascular surgery, which may include carotid endarterectomy or carotid artery stenting. Your surgeon will help to decide which procedure is best suited to the patient. Heart & Vascular Center surgeons offer both options.
Carotid Endarterectomy Procedure
This procedure may be done with patient asleep, or under local anesthesia to numb the neck area and keep the patient awake, allowing for communication with the surgeon during the operation. Staying awake allows the surgeon to monitor the brain’s reaction to decreased blood flow.
To begin surgery, an incision along the side of the neck is made to locate the carotid artery. The surgeon opens the artery, removes the plaque and closes the artery with a patch often made of Dacron fabric.
The procedure takes about two hours to perform and patients stay in the hospital overnight for observation. A small plastic tube is often placed in the neck to collect drainage and removed the next day.
Carotid Angioplasty and Stenting (CAS)
In the procedure, the surgeon introduces a needle into the artery in the groin after injecting numbing medicine. A catheter (flexible plastic tube) is inserted into the artery and carefully guided up to the neck, where the carotid artery blockage is located. Live X-rays, called fluoroscopy, are taken to see the artery during the procedure.
The surgeon then passes a guidewire through the catheter to the blockage. A filter is placed into the normal carotid artery above the blockage to prevent pieces of plaque from breaking off and causing a stroke. A small balloon is pushed over the wire and into the blockage. The balloon is inflated and presses against the inside walls of the artery to open the artery and allow better blood flow to the brain.
Finally, a stent (wire mesh tube) is placed across the blocked area. The stent is inserted to help keep the artery open after balloon treatment.
Carotid endarterectomy and carotid angioplasty and stenting have been proven to reduce the risk of stroke. Patients typically feel well in a matter of days following surgery and see their surgeons within one month following intervention. Temporary nerve injury, leading to hoarseness, difficulty swallowing, or facial numbness, can occur and typically resolves within one month without further treatment. Re-blockage of the carotid artery, called restenosis, can occur years after endarterectomy or stent. Barnes-Jewish & Washington University Heart & Vascular Center surgeons have a 1-2 percent perioperative complication rate, one of the lowest worldwide.
Heart & Vascular Center surgeons participate in clinical trials to assess the efficacy of carotid endarterectomy and carotid stenting. We are active participants in the Society for Vascular Surgery-sponsored Vascular Registry, which maintains patient records in order to measure effectiveness of new treatments. With more than 13,000 patients registered, we can follow long-term outcomes data on patients who undergo either carotid endarterectomy or stenting. Worldwide, our surgeons provide among the best short- and long-term outcomes for carotid endarterectomy and carotid angioplasty and stenting.
To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.