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Carotid Occlusive Disease

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Surgery for Carotid Occlusive Disease

The goal of surgery for carotid occlusive disease is to restore good blood flow to the brain, either by reopening the artery to a healthy width or removing the blockage that’s preventing blood flow. Patients diagnosed with carotid stenosis should be evaluated by a neurosurgeon to determine the most effective course of surgical treatment. Surgery is sometimes performed on an emergency basis, when the patient has had a stroke and the blockage must be removed immediately.

Options for surgical treatment include angioplasty/stenting and endarterectomy, which may be used in combination to treat an occlusion.

Carotid angioplasty for carotid occlusive disease

Carotid angioplasty, also called balloon angioplasty, is a minimally invasive procedure in which a small catheter is inserted into an artery in the groin and threaded up to the carotid artery. A tiny balloon on the tip of the catheter is then inflated, widening the artery at the spot where it’s narrowed or blocked.

Angioplasty is also used to place a stent in the artery.

Carotid stenting for carotid occlusive disease

Carotid artery stenting involves the placement of a small self-expanding stent (tube) inside the narrowed artery. The wire-mesh stent is threaded up to the carotid artery from the groin, and is expanded once it reaches the blockage. The stent holds the carotid artery open to a sufficient width to allow good blood flow to the brain. A stent is usually placed as part of a carotid angioplasty.

Carotid endarterectomy for carotid occlusive disease

Carotid endarterectomy is an open surgical procedure that’s used to remove the blockage from the carotid artery. The surgeon makes a small incision in the neck, then carefully opens the carotid artery and removes the blockage, reconstructing the artery walls to ensure smooth blood flow. In some cases, the neurosurgeon may patch in part of a healthy blood vessel from the patient’s leg, or use a synthetic blood vessel, to replace the damaged artery.

Whichever procedure is deemed appropriate, it should be performed in a major medical center with highly experienced neurosurgeons. Use our online form to request an appointment for evaluation or second opinion, or set up a secure online account where you may upload images for a second opinion.

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Reviewed by Y. Pierre Gobin, M.D.
Last reviewed/last updated: September 2020
Illustrations by Thom Graves, CMI