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Stroke: Should I Have Carotid Endarterectomy?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Stroke: Should I Have Carotid Endarterectomy?

Get the facts

Your options

  • Have carotid endarterectomy surgery.
  • Don't have surgery. Keep taking medicines, or talk with your doctor about other treatment.

Key points to remember

  • Two carotid arteries supply blood to the brain. When plaque builds up in either artery, it can partly block the blood flow to your brain and can cause a stroke or transient ischemic attack (TIA). Carotid endarterectomy may help to prevent this.
  • You are most likely to benefit from carotid surgery if you have had symptoms of a TIA or stroke in the past 6 months and plaque is blocking nearly three-quarters of one of your carotid arteries. Your doctor may call this "70% narrowing."1
  • If less than half of the artery is blocked by plaque, the risks of surgery are greater than the benefits. Your doctor may call this "50% narrowing."1
  • Your doctor may recommend surgery even if your arteries are only moderately blocked (50% to 69% narrowing) if you have had one of the following:
    • One or more TIAs in the past 6 months.
    • A series of small strokes in the past 6 months, and each small stroke has left you a little more disabled.
    • A mild or moderate stroke in the past 6 months.
  • If you and your doctor decide that you need surgery, it is important to have it done by a skilled surgeon at a hospital that has a good success rate in carotid endarterectomy. A good success rate means complication in less than 6 out of 100 of these surgeries.2
  • If you have less than 70% narrowing, taking medicines may work just as well as surgery to prevent a stroke or TIA, especially if you haven't already had one.2
  • You may be able to try other treatment to reduce your risk of TIA and stroke. This could include taking medicines and making healthy lifestyle changes. Or you might be able to have carotid artery stenting. Carotid artery stenting is a minimally invasive procedure that can be used to open narrowed carotid arteries. Talk with your doctor to find out if these treatments are right for you.
FAQs

What is carotid endarterectomy?

Carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is surgery to remove fatty buildup (plaque) from one of the carotid arteries.

Carotid arteries supply blood to the brain. When plaque builds up in either artery, it can partly block the blood flow to your brain. This surgery may lower your risk of having a transient ischemic attack (TIA) or stroke.

During carotid endarterectomy, your surgeon:

  • Will make a cut in your neck just below the jaw.
  • Will open the carotid artery and carefully remove the plaque.
  • May sew (graft) a vein from your leg onto the carotid artery to widen or repair the artery.
  • Will close the artery and skin incisions with stitches.

What kinds of tests can help you decide if surgery is right for you?

You may have tests to measure the amount of plaque in your carotid arteries. These tests also help your doctor see how well blood flows through the area that is narrowed by plaque. Tests may include:

  • Carotid arteriogram.
  • Carotid ultrasound.
  • Computed tomography angiogram (CTA).
  • Magnetic resonance angiogram (MRA).

Most of the time, the amount of narrowing is described as a percentage. For example, if plaque is blocking half of the artery, the doctor may say the artery is 50% narrowed. If plaque is blocking nearly three-quarters of the artery, the doctor may say the artery is 70% narrowed.

Some of these tests can also check the blood vessels above and below the neck. If those vessels are blocked or damaged, surgery may not be helpful because the surgeon cannot easily operate on those areas.

No test can tell for sure which plaques are likely to cause a blood clot to form and cause a TIA or stroke. But experts believe that irregular, jagged, or unstable plaques are more likely than smooth plaques to cause problems.

A person who has a narrowed carotid artery that contains an irregular or jagged plaque may be at greater risk for a stroke or TIA. These tests can help your doctor see what kind of plaque is blocking the artery and whether surgery is a good choice.

How well does this surgery work?

Carotid endarterectomy reduces the risk of TIA and stroke in people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries.1

What are the risks of carotid endarterectomy?

Risks of surgery depend on your age, your health, and the skill and experience of the surgeon.

The major risks are:

  • Stroke, heart attack, and death. Most deaths that occur during this surgery are caused by a heart attack.
  • Breathing problems.
  • High blood pressure.
  • Infection.
  • Nerve injury.
  • Bleeding in the brain.

You and your doctor will decide whether the risks of surgery are higher or lower than your risk of stroke.

Who should not have carotid endarterectomy?

This surgery is not advised for people who have:

  • TIAs that are caused by narrowed blood vessels in the back of the brain.
  • Severe disease of the arteries that bring blood to the heart.
  • Uncontrolled high blood pressure.
  • Severe disease of the arteries that branch off from the carotid arteries.
  • Other serious medical problems, such as kidney failure or heart failure. These can make surgery more risky.

Are other treatments available?

You may be able to try other treatment to reduce your risk of TIA and stroke. These include taking medicines and making healthy lifestyle changes. Or you might be able to have carotid artery stenting.

Medicines

In some people, taking medicines to reduce the risk of blood clots, making lifestyle changes, and taking medicines to control high blood pressure and cholesterol are enough to reduce the risk of transient ischemic attack (TIA) and stroke. If you have less than 70% narrowing of your carotid arteries, especially if you haven't already had a stroke or TIA, medicine may work just as well as surgery to prevent a stroke.2 Talk with your doctor about whether this treatment is an option for you.

Stenting

Carotid artery stenting is similar to coronary angioplasty, which is done to open blocked arteries in the heart. It may be done instead of surgery to prevent TIA or stroke.

In this procedure, a tube is threaded through an artery in the groin and passed up to the carotid arteries. A tiny balloon is used to enlarge the narrowed portion of the artery. A small, expandable tube called a stent is used to keep the artery open.

Carotid artery stenting may work as well as surgery to prevent stroke and other problems in some people who have narrowed carotid arteries.3, 4 Talk with your doctor about whether stenting is an option for you.

Carotid artery stenting is not a good choice for people older than age 70. Studies have shown that for people in this age group, the risk of stroke or death during the procedure is too high. Carotid endarterectomy is safer for people older than 70.

Why might your doctor recommend carotid endarterectomy?

Your doctor may suggest that you have this surgery if:

  • You have had a mild stroke or one or more TIAs in the past 6 months and you have 70% or more narrowing in your carotid artery.
  • You have a low risk of complications from the surgery.
  • You have 50% to 69% narrowing and have had at least one of the following:
    • One or more TIAs in the past 6 months.
    • A series of small strokes in the past 6 months, and each small stroke has left you a little more disabled.
    • A mild or moderate stroke in the past 6 months.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have carotid endarterectomy Have carotid endarterectomy
  • You are asleep during the surgery.
  • You stay in the hospital for 1 to 3 days.
  • You can go back to your daily activities within a week, if they are not too strenuous.
  • Your neck may ache for up to 2 weeks after carotid endarterectomy.
  • Surgery reduces the risk of transient ischemic attack (TIA) and stroke in people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries.1
  • Surgery can be done at any time. But if you have had a TIA or mild stroke, you will benefit most if surgery is done within 2 weeks.
  • The benefits of surgery may not last if you don't take medicines or make healthy lifestyle changes.
  • All surgery has risks, including bleeding, infection, and nerve damage.
  • Other risks include:
    • Stroke, heart attack, and death.
    • Heart and breathing problems.
    • High blood pressure.
Don't have endarterectomy Don't have endarterectomy
  • You can keep taking medicines or try medicines along with lifestyle changes to reduce your risk of stroke.
  • If you decide that surgery is too risky for you, you can talk with your doctor about other treatment, such as carotid artery stenting.
  • You avoid the risks of surgery.
  • Other treatment such as medical therapy or stenting may reduce your risk of TIA and stroke.
  • You may still have a TIA or stroke.
  • You still need to make healthy lifestyle changes to reduce your risk.
  • If you have had symptoms of a stroke or TIA and you have moderate to severe narrowing (70% to 99%) of the carotid arteries, medicines alone may not work as well as surgery to prevent stroke.2

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about carotid endarterectomy surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I had a mild stroke about 3 months ago. Fortunately, it wasn't too bad. With a lot of therapy, I am now able to walk and do many of the things I did before, although my right side is weak. I have a fair amount of narrowing in my carotid arteries, so I am going to have the surgery. I would hate to have another stroke and lose any more function.

David, age 76

I had a mini-stroke (my doctor called it a TIA) about 2 months ago. I had the test that looks at the carotid arteries when the major hospital sent a mobile unit to our area. I have about 65% narrowing in the artery. I could have the carotid surgery, but the closest major hospital is a couple hundred miles away, and I would rather not have surgery so far from home.

Charlene, age 68

I am fortunate to live in a major city that has very good hospitals. My doctor knows his complication rate from carotid surgery, and it is very low. Other than my narrow arteries, I am in good health and I've never had a stroke or even a mini-stroke. I think I stand to gain enough from having surgery to make up for the risks involved in it.

Roberto, age 71

I have never had any symptoms of a stroke or a TIA, although my carotid arteries are about 70% narrowed. The risks of the surgery sound like they are almost as high as the benefit I would gain. Since I don't have any symptoms, I would rather not have surgery for now. Until something happens, I'll take my medicines every day, eat right, and exercise.

Golda, age 67

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have carotid endarterectomy

Reasons not to have endarterectomy

I feel that the benefits of surgery are greater than the risks.

I feel that the risks of surgery are too high for me.

More important
Equally important
More important

I am confident that my surgeon has the skill and experience to perform a successful surgery.

I'm not sure about my surgeon's skill and experience with this surgery.

More important
Equally important
More important

I want to have surgery if it will lower my risk for stroke.

I don't want to have surgery for any reason.

More important
Equally important
More important

I don't want to try other treatments that might not work.

I want to talk with my doctor about other treatments.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having endarterectomy

NOT having endarterectomy

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Are the benefits of surgery highest in people with no symptoms and only a small blockage in their carotid arteries?

  • YesSorry, that's not right. You are most likely to benefit from surgery if you have had symptoms in the past 6 months and you have plaque that is blocking nearly three-quarters of your carotid artery.
  • NoYou're right. You are most likely to benefit from surgery if you have had symptoms in the past 6 months and you have plaque that is blocking nearly three-quarters of your carotid artery.
  • I'm not sureIt may help to go back and read "Get the Facts." You are most likely to benefit from surgery if you have had symptoms in the past 6 months and you have plaque that is blocking nearly three-quarters of your carotid artery.
2.

If you decide that surgery is right for you, does it matter who performs it or where it is done?

  • YesYou're right. It's important to find a skilled surgeon at a hospital that has a good success rate with this surgery.
  • NoSorry, that's not right. It's important to find a skilled surgeon at a hospital that has a good success rate with this surgery.
  • I'm not sureIt may help to go back and read "Get the Facts." It's important to find a skilled surgeon at a hospital that has a good success rate with this surgery.
3.

If you decide that surgery is not for you, are there other treatments you can try?

  • YesYou're right. You may be able to try other treatment, such as taking medicines and making healthy lifestyle changes or having carotid artery stenting. Talk with your doctor.
  • NoSorry, that's not right. You may be able to try other treatment, such as taking medicines and making healthy lifestyle changes or having carotid artery stenting. Talk with your doctor.
  • I'm not sureIt may help to go back and read "Get the Facts." You may be able to try taking medicines and making healthy lifestyle changes or having carotid artery stenting. Talk with your doctor.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology

References
Citations
  1. Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
  2. Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.
  3. Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.
  4. International Carotid Stenting Study Investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomised controlled trial. Lancet, 375(9719): 985–997.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Stroke: Should I Have Carotid Endarterectomy?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have carotid endarterectomy surgery.
  • Don't have surgery. Keep taking medicines, or talk with your doctor about other treatment.

Key points to remember

  • Two carotid arteries supply blood to the brain. When plaque builds up in either artery, it can partly block the blood flow to your brain and can cause a stroke or transient ischemic attack (TIA). Carotid endarterectomy may help to prevent this.
  • You are most likely to benefit from carotid surgery if you have had symptoms of a TIA or stroke in the past 6 months and plaque is blocking nearly three-quarters of one of your carotid arteries. Your doctor may call this "70% narrowing."1
  • If less than half of the artery is blocked by plaque, the risks of surgery are greater than the benefits. Your doctor may call this "50% narrowing."1
  • Your doctor may recommend surgery even if your arteries are only moderately blocked (50% to 69% narrowing) if you have had one of the following:
    • One or more TIAs in the past 6 months.
    • A series of small strokes in the past 6 months, and each small stroke has left you a little more disabled.
    • A mild or moderate stroke in the past 6 months.
  • If you and your doctor decide that you need surgery, it is important to have it done by a skilled surgeon at a hospital that has a good success rate in carotid endarterectomy. A good success rate means complication in less than 6 out of 100 of these surgeries.2
  • If you have less than 70% narrowing, taking medicines may work just as well as surgery to prevent a stroke or TIA, especially if you haven't already had one.2
  • You may be able to try other treatment to reduce your risk of TIA and stroke. This could include taking medicines and making healthy lifestyle changes. Or you might be able to have carotid artery stenting. Carotid artery stenting is a minimally invasive procedure that can be used to open narrowed carotid arteries. Talk with your doctor to find out if these treatments are right for you.
FAQs

What is carotid endarterectomy?

Carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is surgery to remove fatty buildup (plaque) from one of the carotid arteries.

Carotid arteries supply blood to the brain. When plaque builds up in either artery, it can partly block the blood flow to your brain. This surgery may lower your risk of having a transient ischemic attack (TIA) or stroke.

During carotid endarterectomy , your surgeon:

  • Will make a cut in your neck just below the jaw.
  • Will open the carotid artery and carefully remove the plaque.
  • May sew (graft) a vein from your leg onto the carotid artery to widen or repair the artery.
  • Will close the artery and skin incisions with stitches.

What kinds of tests can help you decide if surgery is right for you?

You may have tests to measure the amount of plaque in your carotid arteries. These tests also help your doctor see how well blood flows through the area that is narrowed by plaque. Tests may include:

  • Carotid arteriogram.
  • Carotid ultrasound.
  • Computed tomography angiogram (CTA).
  • Magnetic resonance angiogram (MRA).

Most of the time, the amount of narrowing is described as a percentage. For example, if plaque is blocking half of the artery, the doctor may say the artery is 50% narrowed. If plaque is blocking nearly three-quarters of the artery, the doctor may say the artery is 70% narrowed.

Some of these tests can also check the blood vessels above and below the neck. If those vessels are blocked or damaged, surgery may not be helpful because the surgeon cannot easily operate on those areas.

No test can tell for sure which plaques are likely to cause a blood clot to form and cause a TIA or stroke. But experts believe that irregular, jagged, or unstable plaques are more likely than smooth plaques to cause problems.

A person who has a narrowed carotid artery that contains an irregular or jagged plaque may be at greater risk for a stroke or TIA. These tests can help your doctor see what kind of plaque is blocking the artery and whether surgery is a good choice.

How well does this surgery work?

Carotid endarterectomy reduces the risk of TIA and stroke in people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries.1

What are the risks of carotid endarterectomy?

Risks of surgery depend on your age, your health, and the skill and experience of the surgeon.

The major risks are:

  • Stroke, heart attack, and death. Most deaths that occur during this surgery are caused by a heart attack.
  • Breathing problems.
  • High blood pressure.
  • Infection.
  • Nerve injury.
  • Bleeding in the brain.

You and your doctor will decide whether the risks of surgery are higher or lower than your risk of stroke.

Who should not have carotid endarterectomy?

This surgery is not advised for people who have:

  • TIAs that are caused by narrowed blood vessels in the back of the brain.
  • Severe disease of the arteries that bring blood to the heart.
  • Uncontrolled high blood pressure.
  • Severe disease of the arteries that branch off from the carotid arteries.
  • Other serious medical problems, such as kidney failure or heart failure. These can make surgery more risky.

Are other treatments available?

You may be able to try other treatment to reduce your risk of TIA and stroke. These include taking medicines and making healthy lifestyle changes. Or you might be able to have carotid artery stenting.

Medicines

In some people, taking medicines to reduce the risk of blood clots, making lifestyle changes, and taking medicines to control high blood pressure and cholesterol are enough to reduce the risk of transient ischemic attack (TIA) and stroke. If you have less than 70% narrowing of your carotid arteries, especially if you haven't already had a stroke or TIA, medicine may work just as well as surgery to prevent a stroke.2 Talk with your doctor about whether this treatment is an option for you.

Stenting

Carotid artery stenting is similar to coronary angioplasty, which is done to open blocked arteries in the heart. It may be done instead of surgery to prevent TIA or stroke.

In this procedure, a tube is threaded through an artery in the groin and passed up to the carotid arteries. A tiny balloon is used to enlarge the narrowed portion of the artery. A small, expandable tube called a stent is used to keep the artery open.

Carotid artery stenting may work as well as surgery to prevent stroke and other problems in some people who have narrowed carotid arteries.3, 4 Talk with your doctor about whether stenting is an option for you.

Carotid artery stenting is not a good choice for people older than age 70. Studies have shown that for people in this age group, the risk of stroke or death during the procedure is too high. Carotid endarterectomy is safer for people older than 70.

Why might your doctor recommend carotid endarterectomy?

Your doctor may suggest that you have this surgery if:

  • You have had a mild stroke or one or more TIAs in the past 6 months and you have 70% or more narrowing in your carotid artery.
  • You have a low risk of complications from the surgery.
  • You have 50% to 69% narrowing and have had at least one of the following:
    • One or more TIAs in the past 6 months.
    • A series of small strokes in the past 6 months, and each small stroke has left you a little more disabled.
    • A mild or moderate stroke in the past 6 months.

2. Compare your options

  Have carotid endarterectomy Don't have endarterectomy
What is usually involved?
  • You are asleep during the surgery.
  • You stay in the hospital for 1 to 3 days.
  • You can go back to your daily activities within a week, if they are not too strenuous.
  • Your neck may ache for up to 2 weeks after carotid endarterectomy.
  • You can keep taking medicines or try medicines along with lifestyle changes to reduce your risk of stroke.
  • If you decide that surgery is too risky for you, you can talk with your doctor about other treatment, such as carotid artery stenting.
What are the benefits?
  • Surgery reduces the risk of transient ischemic attack (TIA) and stroke in people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries.1
  • Surgery can be done at any time. But if you have had a TIA or mild stroke, you will benefit most if surgery is done within 2 weeks.
  • You avoid the risks of surgery.
  • Other treatment such as medical therapy or stenting may reduce your risk of TIA and stroke.
What are the risks and side effects?
  • The benefits of surgery may not last if you don't take medicines or make healthy lifestyle changes.
  • All surgery has risks, including bleeding, infection, and nerve damage.
  • Other risks include:
    • Stroke, heart attack, and death.
    • Heart and breathing problems.
    • High blood pressure.
  • You may still have a TIA or stroke.
  • You still need to make healthy lifestyle changes to reduce your risk.
  • If you have had symptoms of a stroke or TIA and you have moderate to severe narrowing (70% to 99%) of the carotid arteries, medicines alone may not work as well as surgery to prevent stroke.2

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about carotid endarterectomy surgery

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I had a mild stroke about 3 months ago. Fortunately, it wasn't too bad. With a lot of therapy, I am now able to walk and do many of the things I did before, although my right side is weak. I have a fair amount of narrowing in my carotid arteries, so I am going to have the surgery. I would hate to have another stroke and lose any more function."

— David, age 76

"I had a mini-stroke (my doctor called it a TIA) about 2 months ago. I had the test that looks at the carotid arteries when the major hospital sent a mobile unit to our area. I have about 65% narrowing in the artery. I could have the carotid surgery, but the closest major hospital is a couple hundred miles away, and I would rather not have surgery so far from home."

— Charlene, age 68

"I am fortunate to live in a major city that has very good hospitals. My doctor knows his complication rate from carotid surgery, and it is very low. Other than my narrow arteries, I am in good health and I've never had a stroke or even a mini-stroke. I think I stand to gain enough from having surgery to make up for the risks involved in it."

— Roberto, age 71

"I have never had any symptoms of a stroke or a TIA, although my carotid arteries are about 70% narrowed. The risks of the surgery sound like they are almost as high as the benefit I would gain. Since I don't have any symptoms, I would rather not have surgery for now. Until something happens, I'll take my medicines every day, eat right, and exercise."

— Golda, age 67

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have carotid endarterectomy

Reasons not to have endarterectomy

I feel that the benefits of surgery are greater than the risks.

I feel that the risks of surgery are too high for me.

       
More important
Equally important
More important

I am confident that my surgeon has the skill and experience to perform a successful surgery.

I'm not sure about my surgeon's skill and experience with this surgery.

       
More important
Equally important
More important

I want to have surgery if it will lower my risk for stroke.

I don't want to have surgery for any reason.

       
More important
Equally important
More important

I don't want to try other treatments that might not work.

I want to talk with my doctor about other treatments.

       
More important
Equally important
More important

My other important reasons:

My other important reasons:

  
       
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having endarterectomy

NOT having endarterectomy

       
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Are the benefits of surgery highest in people with no symptoms and only a small blockage in their carotid arteries?

  • Yes
  • No
  • I'm not sure
You're right. You are most likely to benefit from surgery if you have had symptoms in the past 6 months and you have plaque that is blocking nearly three-quarters of your carotid artery.

2. If you decide that surgery is right for you, does it matter who performs it or where it is done?

  • Yes
  • No
  • I'm not sure
You're right. It's important to find a skilled surgeon at a hospital that has a good success rate with this surgery.

3. If you decide that surgery is not for you, are there other treatments you can try?

  • Yes
  • No
  • I'm not sure
You're right. You may be able to try other treatment, such as taking medicines and making healthy lifestyle changes or having carotid artery stenting. Talk with your doctor.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

     
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerKarin M. Lindholm, DO - Neurology

References
Citations
  1. Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
  2. Furie KL, et al (2011). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 42(1): 227–276. Also available online: http://stroke.ahajournals.org/content/42/1/227.full.
  3. Brott TG, et al. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine, 363(1): 11–23.
  4. International Carotid Stenting Study Investigators (2010). Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): An interim analysis of a randomised controlled trial. Lancet, 375(9719): 985–997.

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