Carotid Revascularization

Vascular Disease

Vascular disease is caused by the build-up of fatty substances that collect and stick to the linings of your arteries, in a process known as atherosclerosis. You may also hear the terms "plaque", "blockage", "lesion", or "stenosis". As the plaque build-up continues, the internal lining of your artery thickens, which causes the artery to narrow and limit blood flow to vital tissues and organs. Some of the more commonly affected arteries are those located in the heart, legs, and neck. The symptoms from these blockages depend on what artery is affected and the severity of the blockages.


Every year, 15 million people worldwide suffer a stroke, also known as a brain attack. Nearly six million die and another five million are left permanently disabled. Carotid artery disease is estimated to be the source of stroke in up to a third of cases and there are 400,000 new diagnoses of carotid artery disease made every year in the United States alone.

Carotid Arteries

The carotid arteries extend from the main artery (aortic arch) coming directly from your heart and supply oxygen-rich blood to the brain. When plaque builds up in the carotid arteries, they begin to narrow and slow down blood flow to the brain. Severe carotid artery disease can cause a stroke if the plaque fragments and small bits of plaque travel to the brain.


You should be screened for carotid artery disease if you have:

  • Weakness, numbness, tingling or paralysis of the arm, leg, or face on one side of your body
  • Trouble swallowing
  • Loss of eyesight or blurry eyesight in one eye
  • Dizziness, confusion, fainting, or coma
  • Unexplained slurred or garbled speech

Sometimes, patients are screened for carotid artery disease if the doctor knows the patient has vascular disease elsewhere in the body. Blockages can also be found when your physician hears a sound through a stethoscope placed on the neck. The sound is caused by blood flowing past the blockage.

The following tests may be performed if carotid artery disease is suspected.

  • Carotid artery ultrasound: This test uses sound waves that produce an image of the carotid arteries on a TV screen, and can be helpful in identifying narrowing in the carotid arteries. This test is painless and does not require the use of needles, dye, or x-rays.
  • Angiography: An angiogram uses x-rays to take a picture of your carotid artery. In order for the x-ray to “see” your arteries, a dye is injected through a small tube (catheter) inserted into an artery in the groin or arm. This procedure will determine exactly where the narrowing is located and will help to guide further treatments.

If carotid disease is diagnosed during one of these tests, your doctor will discuss your treatment options with you.

Treatment Options

Treatment options for carotid artery disease depend upon the severity of the overall patient condition and symptoms. Moderate disease may not require an interventional procedure. More severe blockages may require treatment with open surgery, called carotid endarterectomy, or an endovascular procedure in which a carotid stent is implanted to stabilize the plaque to prevent a future stroke.

Carotid Endarterectomy (open surgery):

This surgical procedure removes plaque from inside of your carotid artery in order to restore normal blood flow to your brain. The surgeon will make an incision on your neck to access the affected artery, open the artery and remove the plaque. The surgeon will then close the artery and the incision in your neck using stitches.

Transfemoral Carotid Artery Stenting:

In this minimally invasive alternative procedure, the physician works through a tube inserted into the artery in the upper thigh. First, a small umbrella-like filter is placed beyond the diseased area of the carotid artery to help limit fragments of plaque from traveling towards your brain during the procedure. The physician then inserts a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow to the brain and stabilize the plaque.

A major complication with all interventional procedure is the possibility of a stroke during the procedure itself. Studies have consistently shown a higher risk of stroke during transfemoral stenting as compared to open surgery.

Transcarotid Artery Revascularization (TCAR):

For patients with carotid artery disease who are at risk for traditional open surgery, a less-invasive, clinically proven alternative called TCAR is available. The TCAR procedure is performed through a small incision at your neckline just above your clavicle. This incision is much smaller than a typical CEA incision. The surgeon will place a tube directly into your carotid artery and connect it to a system that will temporarily direct blood flow away from your brain, to protect against dangerous debris from reaching your brain during the procedure. Your blood will flow through the system and any material will be captured in a filter outside the body. Your filter blood will then be returned through a second tube in your upper thigh. A carotid stent will be implanted to stabilize the plaque and prevent future strokes. After the stent is placed successfully, flow reversal is turned off and blood flow resumes in its normal direction. TCAR has demonstrated the lowest stroke rate of clinical studies to date.