When Does Carotid Artery Disease Need Treatment?

September 27, 2019

Clinical Contributors to this Story

Vikalp Jain, M.D. contributes to topics such as Vascular Surgery.

Carotid artery disease (CAD) is characterized by fatty deposit or plaque build-up in the arteries. There are two main carotid arteries in the neck that deliver blood to the brain. If an obstruction exists in either one, it can increase your risk for developing a stroke.

If you have CAD, there are several treatment options including a new minimally invasive procedure that can reduce your risk.

Living with CAD

Carotid artery disease develops slowly and in its early stages, there are few symptoms. “You may not know you have it unless you experience a stroke or mini-stroke, which is also known as a transient ischemic attack (TIA),” explains Vikalp Jain, M.D., a vascular surgeon in Brick, N.J.

Doctors can evaluate your blood and use imaging tests to determine if you have CAD and the severity of the disease. From there, they work with patients individually to develop management and treatment plans.

CAD Treatment Options

If your CAD isn’t severe, a doctor may want to help you manage your risk factors, such as high blood-fat levels, diabetes and high blood pressure. The risk for CAD can also increase with age.

In its early stages, the doctor may provide aggressive preventative treatment such as medication and lifestyle changes. Common medications used to treat CAD include clopidogrel (Plavix), dipyridamole (Persantine), warfarin (Coumadin) and aspirin, among others. Lifestyle changes involve nutrition counseling and improved diet, as well as regular exercise and quitting smoking.

According to The Society for Cardiovascular Angiography and Interventions, patients who have a blockage less than 50 percent are typically treated with medication and lifestyle interventions. If your blockage is over 50 percent and you have other risk factors, your doctor will determine if you’re a candidate for surgical intervention.

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CAD Surgery

In more severe cases, surgery can be used to treat CAD. Carotid endarterectomy (CEA) is a surgery that requires an incision about 5 to 6 centimeters on the neck to open the carotid artery and remove plaque. Patients stay a day or two in the hospital after this surgery.

Angioplasty is a less-invasive surgical procedure used to treat CAD which involves placing a catheter in the groin, moving it into the carotid artery and then using a balloon to inflate and open up the artery. A stent can be placed, but there is risk that plaque can break off during the procedure and travel to the brain, causing stroke.

TCAR a Minimally Invasive Treatment for CAD

Trans-cervical Carotid Artery Revascularization (TCAR) is a newer, minimally invasive procedure that can dramatically reduce the risk of stroke in patients with CAD.

With TCAR, two smaller incisions are made in the neck and groin that help temporarily reverse the flow of blood away from the brain while the surgeon performs an angioplasty and stenting. This protects against any plaque that may come loose during the procedure from traveling to the brain.

After the stent is placed successfully, holding the artery open and allowing better blood flow, the reversal is turned off and blood flow to the brain resumes in its normal direction.

TCAR doesn’t leave a scar like traditional procedures, it requires less operative time and there’s often a quicker recovery. Most patients are discharged within a day of the procedure.

“TCAR is a viable solution to carotid artery disease for high surgical risk patients because there is a much lower risk of stroke as compared to more traditional approaches,” said Dr. Jain, who has performed the procedure for more than four years. “Because of its low stroke risk and faster patient recovery, TCAR represents the future of carotid repair.”

Ocean Medical Center, Jersey Shore University Medical Center and Hackensack University Medical Center are three hospitals in the Hackensack Meridian Health network to offer TCAR along with the vascular specialists who perform the procedure.

If you have CAD, your doctor will work with you to accurately assess the severity of the disease and then make a recommendation for medication, lifestyle changes or surgical interventions.

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The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.