The carotid artery is a large blood vessel in your neck that carries blood to your brain. Over time, vascular disease can cause blockages in the carotid artery. This condition, called carotid artery stenosis, raises the risk of dangerous strokes.
The Washington University and Barnes-Jewish Heart & Vascular Center is a high-volume center for carotid endarterectomy. That means we have significant experience in this technique, which is the gold standard for treating carotid artery disease and preventing strokes.
Carotid Artery Treatment: Why Choose Barnes-Jewish Hospital?
At the Heart & Vascular Center, you will find:
- High volume of patients: Our surgeons perform more than 200 carotid procedures each year. This high patient volume gives us a strong level of experience. Research shows that patients at higher-volume centers tend to have better outcomes.
- Collaborative, patient-centered care: We focus on improving your quality of life. Your doctors work closely with you and each other to select the right treatment plan. Learn more about vascular surgery at the Heart & Vascular Center.
- Exceptional outcomes: We track the results of more than 13,000 patients who have undergone carotid endarterectomy or stenting to monitor their long-term health. This data shows that our patients have very good results.
- Innovation: Our vascular surgeons actively participate in clinical trials. We were part of the clinical trial to demonstrate the effectiveness of transcarotid artery revascularization (TCAR) with reverse blood flow.
Carotid Artery Problems We Treat
Stenosis is the most common problem affecting the carotid artery. Also known as carotid artery disease, it occurs when a fatty substance called plaque builds up in your carotid artery. This buildup can block blood flow to the brain.
Carotid artery stenosis causes a telltale sign called carotid bruit (pronounced BREW-ee). A carotid bruit is a whooshing sound your doctor can hear through a stethoscope. It also increases the risk of blood clots and stroke. Learn more about carotid artery disease.
Occasionally, people experience a tear in the carotid artery, called a carotid dissection. Dissections can occur due to trauma or for an unknown reason. They may also affect the aorta (major artery from the heart). Carotid dissection treatment is similar to treatment for aneurysms.
Carotid Stenosis Treatments at Barnes-Jewish Hospital
At the Heart & Vascular Center, you have access to the full range of therapies for carotid artery disease. Our ultimate goal is to reduce your risk of stroke.
For patients with significant carotid stenosis, vascular surgery is most appropriate. We generally recommend carotid artery surgery if you have had a stroke or transient ischemic attack (TIA or mini-stroke). Surgery also clears severely blocked carotid arteries.
Your surgical options may include carotid endarterectomy, TCAR or carotid artery stenting. Your surgeon will recommend the procedure that best suits your needs.
Medical treatment for carotid artery stenosis
Not all patients need surgery right away. If the carotid is less than 70 percent to 80 percent blocked and you have no symptoms, your team may recommend nonsurgical treatment. You’ll see your vascular specialist periodically in our clinic to track your symptoms.
Your team may recommend medications to protect your health. Medications to reduce stroke risk due to a carotid artery blockage include:
- anticoagulants (blood thinners) to slow the clotting process
- antiplatelet drugs to prevent excessive clotting
- tissue plasmogen activator (t-PA) to dissolve a clot and treat a TIA in progress
Carotid endarterectomy is the classic surgery to repair the carotid artery. In this procedure, your surgeon opens up the carotid artery, removes the plaque and repairs the artery with a patch to reduce your chance of having a stroke.
Our team is highly experienced in this safe procedure, which takes about two hours. Your surgeon makes an incision along the side of your neck to locate the carotid artery. The surgeon opens the artery, removes the plaque and closes the artery with a patch.
Transcarotid artery revascularization (TCAR)
TCAR is a minimally invasive procedure to clear carotid artery blockages. It’s appropriate for patients of all ages and offers excellent results comparable to invasive surgery. It also provides options for people who aren’t candidates for open surgery.
In TCAR, your surgical team makes a tiny incision in your neck. Your surgery reverses the blood flow to your artery while placing a stent (wire mesh tube) to hold open the carotid. If any clots form during stenting, this reversal sucks the clots back out, minimizing stroke risk. TCAR is also known as transcervical carotid artery stenting with flow reversal.
Our team worked on clinical trials to prove the efficacy of TCAR. Today, we have a high degree of experience in the TCAR procedure.
Transfemoral carotid angioplasty and stenting (CAS)
If you are not a candidate for TCAR, your surgeon may recommend transfemoral angioplasty, another minimally invasive procedure. Transfemoral CAS uses a stent inserted through a blood vessel in your groin to reopen your carotid artery.
During this procedure, the surgeon guides a catheter (flexible plastic tube) to the blockage in your carotid through an artery in your groin. Using a guidewire through the catheter, the surgeon pushes a small balloon into the blockage. The balloon inflates, pressing against the inside walls of the artery to open it. A stent (wire mesh tube) helps keep the artery open after balloon treatment.
Recovering from carotid artery treatment
Most people feel well within a few days after surgery. You will see your surgeon for a follow-up appointment within the month after your procedure.
Carotid artery procedures are generally safe. Some people have temporary nerve injury, which can cause hoarseness, lip drooping, difficulty swallowing or facial numbness. These problems typically resolve within one month without further treatment.
In some people, the carotid artery may become blocked again, a condition called restenosis. It can occur years after endarterectomy or stent.
Our Carotid Artery Team
Our heart specialists work together to provide exceptional care for vascular problems, including carotid stenosis. Find a doctor.
Your carotid artery treatment team may include:
- cardiologists who specialize in heart problems
- vascular surgeons who perform procedures related to arteries and veins
- interventional vascular surgeons and neurointerventional radiologists who perform minimally invasive, catheter-based procedures
- neurologists who specialize in conditions affecting the brain, including stroke
Carotid Artery Research and Clinical Trials
Heart & Vascular Center surgeons participate in clinical trials to assess the efficacy of carotid disease treatment. We are active participants in the Society for Vascular Surgery-sponsored Vascular Registry, which maintains patient records to measure the effectiveness of new treatments. Learn more about our innovation.
To make an appointment with a Washington University vascular specialist at Barnes-Jewish Hospital, call 314-273-7373.