Carotid Artery Interventions

The most common cause of a stroke is a sudden blockage of blood flow to an artery in the brain. The blockage is usually from plaque or a clot located in the carotid artery in the neck that has travelled to the brain. A narrowing, or blockage, of the carotid artery, if severe, is usually treated by surgery to prevent a stroke from occurring. Patients who have already had strokes from this or other conditions can also benefit from surgical intervention. Options for surgical intervention include both carotid artery surgery and carotid artery stenting, a minimally-invasive endovascular approach.

Carotid Artery Surgery (Endarterectomy)

Carotid artery surgery (called an endarterectomy) is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. Endarterectomy may help prevent a stroke from occurring, particularly in patients with a high level of carotid artery narrowing.

Surgery on the carotid artery is usually performed under general anesthesia with continuous brain wave monitoring, but is can also be performed with a regional cervical block.

Robert Wood Johnson University Hospital (RWJUH) surgeons perform over 150 carotid surgeries annually, with outstanding results. While the national average for risk of stoke as a complication of the procedure is 2.5% to 3%, and the New Jersey average is 1.5% to 2%, the stroke risk at RWJUH is only 1%, rivaling the best results of any institution nationwide.

Carotid Stenting

Carotid angioplasty with stenting is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder-like tube made of thin metal-mesh framework used to hold the artery open.

Because there is a risk of stroke from bits of plaque breaking off during the procedure, an apparatus, called an embolic protection device, may be used. An embolic protection device is a filter (like a small basket) that is attached on a guidewire to catch any debris that may break off during the procedure.

Endovascular Treatment of Carotid Disease

Endovascular treatment of carotid disease is an emerging technology. Endovascular specialists at RWJUH are among the most well trained in the nation, and can provide carotid artery stenting as an alternative to traditional surgical procedures. RWJUH surgeons are among the leaders in the use of carotid stenting. In addition, with our extensive training and experience, the number of patients we can offer this treatment option is rising rapidly every year. RWJUH will also soon be recruiting patients for enrollment in two nationally sponsored trials for carotid stenting: the Boston Scientific CABANA Trial, and the Abbott Carotid Trial.

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