Carotid Artery Disease

Treatment

Mayo Clinic physicians evaluate patients for narrowed carotid arteries to determine if they are candidates for carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS), a less-invasive procedure.

For patients who exhibit symptoms of carotid artery disease, carotid endarterectomy is often a safe, effective and durable treatment option. Stenting is generally a good option for patients who have no signs of carotid artery disease.

Older patients are at a higher risk for complications from stenting and may derive no more benefit from carotid endarterectomy than from medical treatment.

When Should Carotid Artery Disease Be Treated?

Asymptomatic Carotid Disease
A recent study involving more than 1,600 patients suggests that if carotid artery stenosis has never caused symptoms, the artery should be repaired if its diameter narrows by 50 percent or more.

At Mayo Clinic, each patient is carefully evaluated and an individual treatment plan is developed by a team of highly trained specialists experienced in treating carotid artery disease. Patients who are candidates for surgery must be in general good health, with no illnesses that might increase risks.

Symptomatic Carotid Disease
If the artery is narrowed by more than 50 percent and has caused symptoms, intervention (CEA or CAS) is usually recommended to prevent further symptoms or stroke.

If, despite the symptoms and narrowing of the artery, there is no intervention, the chance of a stroke can be as high as 26 percent over two years. If the artery is repaired, this risk is reduced to 9 percent.

If the artery is narrowed by more than 50 percent but less than 70 percent, repairing the artery may help prevent future problems.

Artery Narrowed Less Than 50 Percent
There is no proven benefit from intervention to repair an artery that is narrowed less than 50 percent. Medical treatment such as taking one adult aspirin or other antiplatelet agent a day and controlling risk factors is often as effective as repair.

If narrowing of the arteries is identified, close follow-up is recommended, regardless of the degree of blockage.