Most people with plaque in their carotid artery can be treated with medications and lifestyle changes alone. However, people with more severe blockages are at a higher risk for having a stroke and should be evaluated to see if they need more aggressive treatment.
At NYU Langone, our doctors treat most people with severe carotid artery disease with surgery to remove blockages. This includes people with blockages of 80 percent or more of the width of the artery, whether or not they have symptoms. People with smaller blockages—50 percent or more—who have had a ministroke or stroke also typically have surgery to remove the blockage.
Our vascular surgeons are leaders in performing endarterectomy with local anesthesia, which some people may prefer to general anesthesia.
Carotid angioplasty with stenting provides an alternative for those who are not good candidates for surgery because of the irregular shape, or anatomy, of their arteries, or other medical conditions that make surgery dangerous.
At NYU Langone, most people with severe blockages in the carotid arteries, whether or not they have symptoms, are treated with carotid endarterectomy with local anesthesia.
In this procedure, the surgeon numbs the side of the neck with a local anesthetic and makes an incision near the carotid artery. Next, he or she temporarily clamps the carotid artery, opens it with an incision, and, sometimes, inserts a shunt, which is a tube that ensures normal blood flow to the brain during the procedure.
Using local instead of general anesthesia allows the doctor to immediately and accurately determine whether a shunt is necessary during the procedure. This is because it is easier for the doctor to monitor blood flow to the brain when you are awake.
The surgeon then removes the plaque and closes the incision in the artery using a synthetic or biological patch, which may be made from a vein in the body, that widens the carotid artery to help prevent a renarrowing of the artery.
The clamps on the artery are then removed, restoring normal blood flow to the brain.
The surgery takes about two hours and typically requires an overnight stay in the hospital. Normal activities can typically resume within several weeks.
Some people with carotid artery disease may benefit from carotid angioplasty and stenting, an alternative procedure that pushes the plaque against the walls of the carotid arteries, widening the pathway for the blood. It is performed using local anesthesia.
Carotid angioplasty and stenting may be the best option for people who are too frail for endarterectomy and for those with certain features of the carotid arteries that might make surgery difficult.
During carotid angioplasty, also called balloon angioplasty, the doctor makes a tiny incision in the groin to access the femoral artery. He or she then advances a long hollow tube called a catheter to the blockage in a carotid artery in the neck. A filter is used past the area of the blockage to prevent any pieces of plaque from breaking off and traveling to the brain during the procedure.
A tiny balloon at the end of the catheter is inflated, pushing plaque to the sides of the arterial walls. Next, the surgeon inserts a small metallic mesh tube called a stent into the artery, which opens it. This stent prevents the carotid artery from renarrowing.
The surgeon removes the balloon, the filter, and the catheter, but leaves the stent in place permanently.
The procedure lasts 90 to 120 minutes and typically requires a one-night stay in the hospital. You can likely resume everyday activities within two days.