Carotid Disease – Stroke Awareness Month – May 2017

Moderate Carotid Artery Stenosis.

Carotid Artery Stenosis is a common cause of stroke.  In fact, roughly 7 to 18% of all first time stroke is attributed to carotid artery stenosis in excess of 60%.  That means that roughly 1 in 10 strokes is due to narrowing of the carotid artery.

There is debate regarding the best treatment for carotid artery stenosis. I won’t get into the relative risks and benefits of each in this post, but in general the treatment options for carotid stenosis include:

  1. Medical Treatment – aggressive medical treatment usually involves aspirin, clopidogrel, a statin, as well as aggressive blood pressure and diabetes control.  This may be the best option for asymptomatic carotid stenosis.
  2. Carotid Endarterectomy (Surgery) – this is a surgical procedure in which an incision is made on the neck and the carotid artery is exposed.  The artery is then temporarily occluded with clamps.  The artery is then opened with a scalpel, the plaque is removed, and then the artery is repaired.  This has been a common treatment for many decades, and is well studied with very good results.
  3. Carotid Angioplasty and Stent (Endovascular Treatment) – this is an endovascular procedure to treat carotid disease.  This is done awake in the
    Pre-Treatment, severe >90% left internal carotid artery stenosis. The arrow denotes severe stenosis, or narrowing. This is seen as a tiny string of contrast at the arrow. The external carotid artery, which supplies blood to the face and scalp, fills much more rapidly than the internal carotid artery, which supplies the brain.

    cath lab.  A guide sheath is placed into an artery in the leg, it is navigated to the common carotid artery in the neck, and then the carotid narrowing is treated from within the blood vessel.  The narrowed carotid artery is ballooned opened with a balloon catheter and a stent is placed to help keep the artery open.  In the images to the right and below, there is a representative example of the treatment of left internal carotid stenosis with angioplasty and stent placement.  In the image to the right, the narrowing is a tiny string of contrast at the arrow, which is causing severe limitation in flow into the left internal carotid artery.  Below, you can see the post angioplasty and stent results, after the narrowing has been “ballooned open” and a stent placed.

Post carotid angioplasty and stent placement.
Post treatment, unsubtracted and magnified to see stent inside left internal carotid artery.








Dr. Lawson treats carotid disease with all of the methods noted above; medical, surgical, and endovascular.  All of his carotid procedures are tracked in a registry (the National Neurosurgery Quality and Outcomes Database, also known as QOD – Neurovascular module) to ensure quality and safety.  Learn more about public quality data reporting at the Neuropoint Alliance.

Want to learn more?  Download the American Stroke Association guidelines for the management of carotid disease here.

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