Carotid Artery Disease
What is carotid artery disease?
Buildup of plaque within the main arteries of the neck (carotid atherosclerosis), causing the artery opening to narrow (carotid stenosis).
Why is carotid artery disease dangerous?
Fragmented plaque creates atheroembolic debris that may become lodged in the small arteries within the brain, causing stroke.
How do I know if I have carotid artery disease?
Carotid artery disease can be asymptomatic or symptomatic, and diagnosed through one of several noninvasive procedures.
Treatment for Carotid Artery Disease
Nonsurgical and surgical (angioplasty, stenting, endarterectomy) treatment options.
What happens during a carotid endarterectomy?
A 1.5-hour surgery procedure generally performed under local anesthesia.
Benefits and Complication of Carotid Artery Surgery
Artery surgery proven to reduce the risk of stroke, quick recovery vs. risk of perioperative stroke.
Carotid Artery Surgery, Angioplasty, Stenting Research at NYU
Current clinical trials evaluating and debating the best treatment methods for carotid artery disease.
Why Choose NYU for Carotid Artery Surgery?
The largest team of top-level vascular specialists, members of a leading academic medical center in New York City. Surgeons with commitment to finding the best treatment methods, success in surgical outcomes, extensively published medical experts who lead vascular research and treatment worldwide.
NYU’s Expert Surgeons
Listing of NYU surgeons who treat patients with carotid artery disease.
What is carotid artery disease?
Carotid artery disease occurs when plaque builds up within the main arteries of the neck (carotid atherosclerosis), causing the artery opening to narrow (carotid stenosis). The carotid arteries in the front of the neck and the vertebral arteries in the back of the neck carry the main blood supply to the brain. These arteries connect with one another in the brain through the Circle of Willis.
Carotid artery disease increases the risk of stroke and resulting complications (see below: "Why is carotid artery disease dangerous?").
Arterial blockage can be asymptomatic or symptomatic, diagnosed through a number of noninvasive venues (see below: "How do I know if I have carotid artery disease?").
Surgical and nonsurgical treatment is available for carotid artery disease (see below: "Treatment for Carotid Artery Disease"). Surgery (stenting, angioplasty, carotid endarterectomy) is considered the most effective treatment method.
Vascular surgeons at NYU Medical Center provide critically informed, actively tested expert medical treatment for carotid artery disease (see below "Carotid Artery Surgery, Angioplasty, Stenting Research at NYU"). Treatment is individualized to each patient’s unique vascular health needs.
More information about carotid artery disease is available on the Society for Vascular Surgery website.
Why is carotid artery disease dangerous?
Plaque that builds up in the carotid artery may fragment, creating atheroembolic debris, and pieces of the plaque may become lodged in the small arteries within the brain.
The brain receives about 25% of the body’s blood supply, but it cannot store oxygen. Brain cells require a constant supply of oxygen to stay healthy and function properly.
When blood flow to the brain is interrupted and the brain’s supply of oxygen is reduced for even a short period of time, brain tissue can become damaged and small areas of brain death may occur. This condition, known as stroke, may render a range of impaired motor, visual, speaking and cognitive functioning.
How do I know if I have carotid artery disease?
Patients who have severe blockage in the carotid arteries without symptoms have a condition known as asymptomatic carotid stenosis.
Patients who have had a stroke or "ministroke" (transient ischemic attack) have symptomatic carotid stenosis.
Regardless of whether their carotid stenosis is asymptomatic or symptomatic, patients may require treatment of their carotid artery plaque.
How is carotid artery disease diagnosed?
Carotid artery stenosis is diagnosed through one of the following noninvasive procedures:
- Detection of a bruit (whooshing sound) in the neck, heard through a stethoscope.
- Duplex scan (ultrasound). The duplex scan is the most common first test in the diagnosis of carotid artery stenosis.
- Magnetic resonance angiography (MRA), or use of a magnetic resonance imaging machine (MRI) to produce a detailed picture of the carotid arteries.
Treatment for Carotid Artery Disease
Nonsurgical Treatment for Carotid Artery Disease
Carotid artery plaque may be treated with blood thinners and antiplatelet agents such as aspirin. Surgery, however, is the most effective medical therapy in preventing stroke.
Carotid Artery Surgery
Surgical treatment options for carotid atherosclerosis are angioplasty, stenting, and carotid endarterectomy surgery.
Some research studies have shown that angioplasty and stenting produce more favorable results in treating atherosclerosis, other studies have shown better results through carotid endarterectomy.
NYU’s Critically Tested, Informed, Individualized Treatment Approach
Patients who have carotid artery disease should choose a surgeon who can perform both angioplasty and stenting and carotid endarterectomy surgery.
In order to determine the best course of treatment for each patient, NYU’s vascular surgeons critically evaluate certain characteristics of that patient’s general health and anatomy.
Surgeon at NYU continually evaluate and debate the use of angioplasty and stents over cartoid endarterectomy in treating carotid atherosclerosis. Current clinial trials include:
- Carotid Revascularization Endarterectomy vs. Stent Trial (CREST)
Contrasts the relative efficacy of carotid artery stenting vs. carotid endarterectomy in preventing stroke, myocardial infarction, and death in patients with symptomatic and asymptomatic extracranial carotid stenosis. - Asymptomatic Carotid Stenosis, Stenting vs. Endarterectomy Trial (ACT 1)
Seeks to demonstrate that carotid artery stenting using the Emboshield Cerebral Protection System with the Xact RX Carotid Stent System is equally effective to carotid endarterectomy in treating asymptomatic extracranial carotid stenotic disease. - The Embolic Protection with Reverse Flow (EMPiRE) Study of the GORE Neuro Protection System in Carotid Stenting of Subjects at High Risk for Carotid Endarterectomy
Assesses the safety and effectiveness of the GORE Neuro Protection System in providing embolic protection during carotid artery angioplasty and stenting procedures in high-risk surgical subjects. - Carotid artery plaque characterization using helical CT: effect of plaque morphology on morbidity following carotid endarterectomy and carotis artery stent procedures
Studies the occurrence of neurological changes based on cognitive testing done before and after carotid artery surgery, including carotid artery endarterectomy.
What happens during a carotid endarterectomy?
Once the diagnosis of significant carotid stenosis is made (see above: "What is carotid artery disease?"), the most appropriate therapy is vascular surgery, which may include carotid endarterectomy or carotid artery stenting. Your surgeon will help you decide which procedure is best for you. NYU’s vascular surgeons offer both surgery options. Treatment is individualized to each patient.
At New York University Division of Vascular Surgery, 85% of carotid endarterectomies are performed under local anesthesia.
The surgery takes approximately 1.5 hours. Patients are admitted to the hospital on the same day of surgery.
Carotid Endarterectomy Procedure
- A local anesthetic is administered and surgery begins.
- The surgeon makes an incision along the side of the neck and locates the carotid artery.
- The surgeon opens the artery, removes the plaque, and closes the artery with a patch commonly made of Dacron fabric.
- Patients typically stay in the hospital overnight for observation.
Benefits and Complication of Carotid Artery Surgery
Carotid endarterectomy has been proven to reduce the risk of stroke
Patients typically feel well in a matter of days following surgery.
Complications of Carotid Artery Surgery
The most common complication associated with surgery is stroke, which can occur in the perioperative period (during or shortly following surgery).
NYU’s vascular surgeons have a 1–2% perioperative complication rate, one of the lowest worldwide, and a 1.5% morbidity rate in preventing stroke by removing plaque from arteries, the lowest in New York state.
Carotid Artery Surgery, Angioplasty, Stenting Research at NYU
Surgeons at NYU continually evaluate and debate the use of angioplasty and stents over carotid endarterectomy in treating carotid atherosclerosis. Current clinical trials include:
- Carotid Revascularization Endarterectomy vs. Stent Trial (CREST)
Contrasts the relative efficacy of carotid artery stenting vs. carotid endarterectomy in preventing stroke, myocardial infarction, and death in patients with symptomatic and asymptomatic extracranial carotid stenosis. - Asymptomatic Carotid Stenosis, Stenting vs. Endarterectomy Trial (ACT 1)
Seeks to demonstrate that carotid artery stenting using the Emboshield Cerebral Protection System with the Xact RX Carotid Stent System is equally effective to carotid endarterectomy in treating asymptomatic extracranial carotid stenotic disease. - The Embolic Protection with Reverse Flow (EMPiRE) Study of the GORE Neuro Protection System in Carotid Stenting of Subjects at High Risk for Carotid Endarterectomy
Assesses the safety and effectiveness of the GORE Neuro Protection System in providing embolic protection during carotid artery angioplasty and stenting procedures in high-risk surgical subjects. - Carotid artery plaque characterization using helical CT: effect of plaque morphology on morbidity following carotid endarterectomy and carotis artery stent procedures
Studies the occurrence of neurological changes based on cognitive testing done before and after carotid artery surgery, including carotid artery endarterectomy.
Why Choose NYU for Carotid Artery Surgery?
NYU Medical Center’s vascular surgeons perform all types of carotid artery surgery — artery stenting, angioplasty, and carotid endarterectomy—and critically evaluate each patient’s unique vascular health needs to produce the best individualized treatment plan.
NYU Medical Center’s Division of Vascular Surgery offers the largest team of top-level vascular specialists in New York City. Members of a leading academic medical center, NYU’s vascular surgeons are deeply committed to finding the most advanced, innovative, proven methods to treat carotid artery atherosclerosis.
NYU’s vascular surgeons have proven success in their outcomes: a 1–2% perioperative complication rate, one of the lowest worldwide, and a 1.5% morbidity rate in preventing stroke by removing plaque from arteries, the lowest in New York state.
NYU’s vascular surgeons are academic experts in the area of carotid artery disease, having written volumes of articles, books, and papers on subjects including atherosclerosis, carotid artery stenosis, carotid artery stents, angioplasty, and carotid artery endarterectomy surgery. Vascular surgeons at NYU have contributed to the 2 most important papers published in medical literature regarding carotid stenosis:
1. "Endarterectomy for asymptomatic carotid artery stenosis"
Journal of the American Medical Association. 1995, 273:1421-1428.
Details the Asymptomatic Carotid Artery Stenosis (ACAS) trial in which carotid endarterectomy proved more beneficial than medical management for asymptomatic carotid stenosis.
2. New England Journal of Medicine. 1991, 325:445-453.
The North American Symptomatic Carotid Endarterectomy Trial (NASCET), the most important trial for symptomatic carotid stenosis, demonstrated that carotid endarterectomy was more beneficial than medical therapy for symptomatic high-grade carotid artery stenosis.
Our Carotid Artery Disease Specialists
NYU Langone Medical Center
550 First Avenue
New York, NY 10016
1-877-4-NYUCVI (698284)
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Timothy Clark, M.D.
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Mark A. Adelman, M.D.
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Hearns Charles, M.D.
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Neal Cayne, M.D.
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Richard Lefleur, M.D.
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Glenn R. Jacobowitz, M.D.
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Hillel Bryk, M.D. |
Lowell S. Kabnick, M.D. |
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Theresa Aquino, M.D. |
Patrick J. Lamparello, M.D. |
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Sandor Kovacs, M.D. |
Thomas Maldonado, M.D. |
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Firas F. Mussa, M.D. |
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Thomas S. Riles, M.D. |
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Caron Rockman, M.D. |
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Frank J. Veith, M.D. |
