Do you need treatment for carotid artery disease?
Treatment options for carotid artery disease depend upon the severity of the overall patient condition and symptoms. Moderate disease may not require an interventional procedure. More severe blockages may require treatment with open surgery, called carotid endarterectomy, or an endovascular procedure in which a carotid stent is implanted to stabilize the plaque to prevent a future stroke.
Carotid Endarterectomy (CEA)
This 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.
Transfemoral Carotid Artery Stenting
In this minimally invasive alternative procedure, the physician works through a tube inserted into the artery in the upper thigh. First, a small umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling toward the brain during the procedure. The physician then inserts a slender, metal-mesh tube, called a stent, which expands inside the carotid artery to increase blood flow to the brain and stabilize the plaque.
TransCarotid Artery Revascularization (TCAR)
Brown Surgical Associates is pioneering the use of a breakthrough technology called TransCarotid ArteryRevascularization (TCAR) to treat patients with carotid artery disease who are at risk for open surgery. Dr. Jeffrey Slaiby was the first in Rhode Island and one of the first in the entire Northeast to perform the procedure in June of 2017.
While any repair of the carotid artery carries some risk of causing a stroke because of the repair itself, TCAR was designed to help minimize that risk by keeping potential stroke-causing fragments away from the brain. Like the open surgery, carotid endarterectomy (CEA), this new procedure involves direct access to the carotid artery, but through a much smaller incision at the neckline just above the clavicle instead of a longer incision on the neck. 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 during the procedure. Surgeons then filter the blood before returning it to a vein in the groin, and a stent is implanted directly into the carotid artery to stabilize the plaque and prevent future strokes. The entire procedure is performed in less than half the time of CEA –limiting the stress on the heart and significantly cutting the risk of the patient having a stroke or heart attack during the procedure.
Patients who undergo the TCAR procedure recover quickly (typically spending just one night in the hospital) and almost always go home the next day to return to full and productive lives with less pain, smaller scars, and a reduced risk of future strokes. Your physician may recommend the TCAR procedure if you’ve been diagnosed with carotid artery disease and are not a suitable candidate for CEA. This may depend on your age or other existing medical conditions.