Mayo Clinic's approach

Teamwork

The Mayo Clinic approach to the patient with carotid disease brings together doctors from neurology, neurosurgery, radiology, vascular and endovascular surgery, cardiovascular diseases, and vascular medicine to care for people receiving carotid endarterectomy.

Your Mayo Clinic team of specialists takes the time to listen and get to know you and your concerns — and collaborate with each other to determine the best approach for your individual needs. You can trust our specialists to work together to provide you with the highest level of safety, service and care.

Experience

Mayo Clinic doctors and surgeons are trained and experienced in performing carotid endarterectomy, carotid angioplasty and stenting, and other complex vascular surgeries to treat carotid artery disease. Mayo Clinic doctors trained in blood vessel surgery (vascular surgeons), brain surgery and blood vessel surgery (neurosurgeons), brain and cerebrovascular conditions (neurologists), heart and blood vessel conditions (cardiologists), and imaging techniques (interventional neuroradiologists) have experience evaluating and treating people with carotid artery disease who may need carotid endarterectomy. Mayo Clinic surgeons perform more than 190 carotid endarterectomy procedures each year.

Research

Mayo Clinic experts are constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Mayo Clinic doctors are directly involved in research in the treatment of carotid stenosis, most notably in leading the multicenter Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) and currently the CREST-2 trial. Your doctor or someone on your medical team is likely involved in research related to your condition.

CREST Trial

Vivien Williams: Carotid artery disease increases your risk of stroke. Plaque builds up in the arteries in the neck, and if some breaks away, it could travel to your brain and cut off blood flow. But results of a study published in the New England Journal of Medicine give doctors the information they need to choose the best preventive procedures for their patients.

It’s called the CREST Trial — Carotid Revascularization Endarterectomy versus Stent Trial. What that means is researchers tested open surgery versus stenting of the carotid artery to see which procedure was best at opening blockages and preventing stroke. Findings show that open surgery and stenting are equally safe and effective at preventing stroke, except for people over the age of 80.

Albert Hakaim, M.D.—Mayo Clinic vascular surgery: Based on the CREST Trial for patients who are older and the majority of vascular patients are older, carotid endarterectomy is superior to stentings.

Vivien Williams: Dr. Albert Hakaim says, people over 80 who have stents placed to open blockages in their carotid arteries have a higher risk of stroke after treatment than those who had the open operation. But if you're younger, both procedures are equally beneficial.

You see, blockages happen after years of plaque buildup on the artery walls. If a piece breaks off, it could flow to the brain and cut off blood supply, causing stroke. Here's a comparison of the two procedures.

First, the standard operation. With the patient under general anesthesia, Dr. Hakaim makes an incision in the neck to expose the carotid artery which carries blood to the face and brain. Then he inserts a temporary shunt to reroute blood so they can work on the artery. Next, he opens the artery lengthwise, removes plaque, and closes the incision.

Stenting is less invasive. With the patient having local anesthesia, Dr. Hakaim advances a catheter through the femoral artery in the leg up to the blockage. Just above it, he places a tiny umbrella shaped device to make sure that if the pieces of plaque break off they don't flow to the brain. Then he deploys the stent, which is pushed into place by a balloon. The stent opens the artery and crushes the plaque against the artery wall.

Albert Hakaim, M.D.: So here's the common carotid artery. And this is where the artery branches, so this branch goes to the face. This was the narrowing. This is the stent before the angioplasty.

Vivien Williams: Two procedures, both safe and effective at preventing stroke in the right groups of patients. The CREST Trial is important, because stroke is the third leading cause of death in the U.S. and the number one cause of disability. Now doctors can be more certain that the procedures they do for their patients will reduce the risk of stroke. For Medical Edge, I'm Vivien Williams.

Nationally recognized expertise

Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for neurology and neurosurgery and for heart and heart surgery by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals in neurology and neurosurgery and for heart and heart surgery.

Expertise and rankings

Mayo Clinic surgeons are experienced in carotid endarterectomy, performing more than 190 carotid endarterectomy procedures each year.

Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for neurology and neurosurgery and for heart and heart surgery by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals in neurology and neurosurgery and for heart and heart surgery.

Locations, travel and lodging

Mayo Clinic has major campuses in Phoenix and Scottsdale, Arizona; Jacksonville, Florida; and Rochester, Minnesota. The Mayo Clinic Health System has dozens of locations in several states.

For more information on visiting Mayo Clinic, choose your location below:

Costs and insurance

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people.

In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals, or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Learn more about appointments at Mayo Clinic.

Please contact your insurance company to verify medical coverage and to obtain any needed authorization prior to your visit. Often, your insurer's customer service number is printed on the back of your insurance card.

More information about billing and insurance:

Mayo Clinic in Arizona, Florida and Minnesota

Mayo Clinic Health System

Clinical trials

Explore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions.

Dec. 11, 2018
  1. What is carotid artery disease? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/catd/. Accessed Dec. 29, 2017.
  2. What is carotid endarterectomy? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/carend/. Accessed Dec. 29, 2017.
  3. Mohler ER, et al. Carotid endarterectomy. https://www.uptodate.com/contents/search. Accessed Dec. 29, 2017.
  4. Mohler ER, et al. Management of asymptomatic carotid atherosclerotic disease. https://www.uptodate.com/contents/search. Accessed Dec. 29, 2017.
  5. Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. Sept. 28, 2017.