Extracranial (Brachiocephalic) Atherosclerosis Treatment
If the carotid artery is minimally constricted due to blockage, medical treatment may be recommended. However, if significant blockage is present, surgery (endarterectomy) is usually performed. Designed to remove the plaque causing the constriction which in turn allows the blood to flow more freely, endarterectomy is becoming increasingly more common, and is often referred to as “the gold standard” treatment for carotid atherosclerosis. Endarterectomy is especially recommended for patients who have significant blockage.
In 2004, a minimally invasive treatment for carotid atherosclerosis called carotid stenting received FDA approval. This procedure is performed by opening the artery with a small tube and then inflating a balloon catheter to press the plaque into the sides of the artery wall. Similar to angioplasty, this procedure is also utilized in the heart. Subsequently, a stent, or supportive tube, is then placed in the artery to cover the plaque and help keep the vessel open.
In deciding between surgery and stenting to treat carotid atherosclerosis, doctors consider the patient’s overall health condition. In cases where a patient is symptomatic and at high risk for surgery (experiencing poor health in general, manifesting a heart condition or experiencing a previous stroke), angioplasty and stenting has been proven in a recent trial to be at least as effective as surgery. However, the same trial also proves that as stroke and death rates for carotid stenting range from 4.4% to over 12% at 30 days, with a one-year stroke and death rate of up to 12%, neither carotid stenting nor surgery may be a good option for patients with no symptoms from their stenosis.
In cases where a narrowing or stenosis is present in the vertebral artery, angioplasty and stenting are usually performed.