There are two carotid arteries (right and left); these are the main arteries that carry blood from the neck to the brain. A blocked carotid artery may be due to fatty deposits (called plaque), or to a blood clot trapped in a carotid artery narrowed by plaque. A stroke often occurs when a carotid artery becomes blocked and the brain does not get enough oxygen. Treatment options for a blocked carotid artery include drugs, carotid angioplasty-stent (CAS) and surgery (carotid endarterectomy).
Drugs
If a person is having a stroke due to a blood clot from a blocked carotid artery, the clot-busting drug tPA, or tissue plasminogen activator, can be given intravenously to break up blood clots in the brain. TPA must be given within three hours from the onset of symptoms.
If a person has had an stroke caused by a blood clot, known as ischemic stroke, aspirin or clopidogrel are prescribed to prevent further stroke(s). In most cases, patients will need to take these anticoagulants forever.
According to an article by Dr. KI Paraskevas from the Royal Free Hospital, London, published in the Aug. 2007 issue of the "Journal of Vascular Surgery," current evidence indicates that routine use of "statins," which are drugs that lower cholesterol levels in the blood, reduces the thickening of the inside of carotid arteries (carotid intima-media) and stroke risk.
Angioplasty-stent
Carotid angioplasty involves compressing plaque against an artery wall with a balloon catheter; this improves blood flow. Then, a small metal tube, or stent, is placed in the artery to keep it open. Although initial studies are promising, the FDA hasn't approved balloon angioplasty for use in carotid arteries. Angioplasty is less invasive than carotid endarterectomy, which requires surgically opening the artery.
A "New England Journal of Medicine" article published in April 2008 reports on a study that compared carotid stenting with carotid endarterectomy in 334 patients who had risk factors that increased their risk for surgical complications. The lead author of the study, Dr. HS Gurm, writes that at the three-year endpoint, no significant difference could be shown in long-term outcomes between patients who underwent carotid artery stenting with an emboli-protection device and those who underwent endarterectomy.
A 2009 editorial written by Dr. Deepak Bhatt from Harvard Medical School and published in the journal "Circulation" states that patients with blocked carotid arteries who might benefit from stents are elderly patients 80 years or older.
Carotid Endarterectomy
Carotid endarterectomy is a procedure that removes fatty plaque from neck arteries. While the patient is under anesthesia, surgeons make an incision in the neck at the location of the blockage. The artery is isolated and the plaque and diseased portions of the artery are surgically removed, which improves blood flow to the brain.
References
- Surgical Associates of Texas; Diseases and Conditions: Carotid Artery Disease
- "Journal of vascular Surgery"; Statins: an essential component in the management of carotid artery disease; Dr. KI Paraskevas; Aug 2007; 46(2):373-386.
- "New England Journal of Medicine"; Long-Term results of carotid stenting versus endarterectomy in high-risk patients; Dr. S. Gurm, April 2008; 10; 358 (15): 1572-9.
- Circulation: Carotid Stenting in the Elderly: Is 80 the new 60?; Deepak Bhatt, M.D. May 5, 2009; 119:2302-2304
