Multiple Treatments Available When Carotid Arteries Are Blocked

The brain needs blood to function, and any blockage in the carotid arteries - blood’s primary pathway to the brain - requires medical treatment.

Carotid artery blockages are serious. More than half of the strokes in the United States are attributed to carotid artery disease. But, according to an overview of carotid artery stenosis in the June issue of Mayo Clinic Health Letter, not all people with carotid artery disease need surgery or stents to open blocked arteries. The best treatment option depends on the extent of the blockage and whether patients have experienced symptoms as a result.

The carotid arteries run up both sides of the neck. With age, they become more prone to damage and less elastic. Damage that occurs on the inner layers of the arteries allows plaque to build up in a process call atherosclerosis. The changes result in narrowing of the arteries, restricting blood to the brain. Symptoms of a blockage - and warning signs of stroke - can include:

- Sudden weakness, numbness or paralysis on one side of the body that affects the face, arm or leg
- Sudden blindness in one eye
- Slurred or garbled speech or difficulty understanding others
- Loss of balance or dizziness

Any of these conditions indicate a possible stroke and warrant immediate medical attention, even if the symptoms disappear. A doctor can evaluate the health of the carotid arteries with imaging studies and by listening to the blood flow, which has a swooshing sound when there’s a partial blockage. Treatment options include:

Lifestyle changes and medications: This is typically the approach when blockage is less than 60 percent, and no symptoms of stroke are apparent. The goal is to slow the atherosclerosis through exercise, stopping smoking, losing weight if needed, and eating a healthful diet.

In addition, aspirin or blood-thinning medication can reduce the risk of blood clots.

Carotid endarterectomy: This procedure is the most common surgical treatment for severe carotid artery disease. The surgeon makes an incision in the neck, opens the carotid artery and removes the buildup of plaque. When this procedure is performed by an experienced surgeon, the risks are low, even for otherwise healthy patients age 80 or older.

Balloon angioplasty and stent placement: This procedure is an option for patients at high risk for carotid endarterectory. Patients may be precluded from surgery because of the location of the blockage, severe heart or lung disease or kidney disease.

During angioplasty, the surgeon threads a long, hollow tube through the groin artery up to the narrowed carotid artery. A tiny balloon is inflated to open the blockage, and a stent is placed there to keep it open. Large studies are under way to determine if angioplasty might be safe and effective for a larger percentage of people with carotid artery stenosis - not just those at high risk for carotid endarterectomy.