Stroke Prevention: Should I Have a Carotid Artery Procedure?

Decision point

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 Prevention: Should I Have a Carotid Artery Procedure?

Get the facts

Your options

  • Have a carotid artery procedure to prevent a stroke.
  • Don't have a procedure. Keep taking medicines and making healthy lifestyle changes.

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). Having a carotid artery procedure—either carotid endarterectomy or carotid artery stenting—may help to prevent a TIA and stroke.
  • For some people, the medical facts make the choice pretty clear. A procedure is usually recommended if plaque is blocking nearly three-quarters of your artery (70% or more) and you've had a recent stroke or TIA. And it's usually not recommended if less than half (50%) of the artery is blocked.
  • The choice isn't as clear if you're in the middle—your arteries are between 50% and 70% blocked and you have had a recent stroke or TIA. It depends on your symptoms, your health, and your feelings about the risks and benefits.
  • If you have not had a TIA or stroke, medicines may work as well as a procedure to prevent a stroke.footnote 1
  • It's important that the benefits outweigh the risk of serious problems from a procedure.
  • Medicines and healthy lifestyle changes also can help lower your risk of stroke. Even if you have a procedure, you will also take medicine and make lifestyle changes.
FAQs

What are carotid artery procedures?

There are two kinds of carotid artery procedures: endarterectomy and stenting.

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.
  • Will close the artery and skin incisions with stitches.
Carotid artery stenting

Carotid artery stenting is similar to coronary angioplasty, which is done to open narrowed or blocked arteries in the heart.

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.

Stenting is not as common as carotid endarterectomy.

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

You may have tests to measure the amount of narrowing in your carotid arteries. These tests also help your doctor see how well blood flows through the area that is narrowed by plaque. These tests can help your doctor see what kind of plaque is blocking the artery and whether a procedure is a good choice.

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 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.

How well do carotid artery procedures work?

In people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries, carotid endarterectomy reduces the risk of TIA and stroke.footnote 2

Carotid artery stenting may work as well as endarterectomy to prevent stroke in some people who have narrowed carotid arteries.footnote 3, footnote 4

If you have not had a TIA or stroke, it is not as clear when a procedure might be a good choice. Medicine and lifestyle changes may work as well as a procedure to prevent a stroke. Your doctor might recommend a procedure if you have moderate to severe narrowing (more than 70%) and if the benefits of this procedure outweigh the risks.footnote 1

What are the risks of carotid artery procedures?

Risks of carotid procedures depend on your age, your health, and the skill and experience of the doctor. It's important to have these procedures done by a skilled doctor at a hospital that has a good success rate.

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

If you have had a TIA or stroke, a good success rate means complications happen in less than 6 out of 100 of these procedures. That means complications do not happen in more than 94 out of 100 of these procedures.footnote 5

If you have not had a TIA or stroke, it's important that you have a low risk of serious problems so that the benefits of a procedure outweigh the risks. Your doctor can help you know your risk. A low risk is less than 3%.footnote 1

Carotid endarterectomy

Risks of carotid endarterectomy include:

  • Infection.
  • Breathing problems.
  • Nerve injury.
  • Stroke, heart attack, and death.
Carotid artery stenting

Risks of carotid artery stenting include:

  • Infection.
  • Bleeding at the catheter insertion site.
  • Damage to the blood vessel at the catheter insertion site.
  • Stroke, heart attack, and death.

Who should not have a carotid artery procedure?

A carotid procedure is not advised for people who have:

  • TIAs that are caused by narrowed blood vessels in the back of the brain.
  • Severe coronary artery disease.
  • 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.

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.

What medicines and lifestyle changes help prevent stroke?

Medicine and healthy lifestyle changes help lower your risk of stroke. For some people, this is enough to lower their risk. If you have a carotid artery procedure, you will still need to take medicine and make lifestyle changes.

If you haven't already had a stroke or TIA, medicine may work just as well as a procedure to prevent a stroke.footnote 1

Medicines

Medicines that help prevent stroke include:

  • Aspirin or other blood thinners.
  • Blood pressure medicine.
  • Cholesterol medicine called statins.
Lifestyle changes

A healthy lifestyle can help prevent a stroke. This lifestyle includes:

  • Not smoking.
  • Eating heart-healthy foods.
  • Being active.
  • Staying at a healthy weight or losing weight if you need to.

Why might your doctor recommend a carotid artery procedure?

Your doctor may suggest that you have a procedure 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 procedure.
  • 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 a procedure Have a procedure
  • You will likely stay 1 or 2 nights in the hospital.
  • You can go back to your daily activities within a week or two, if they are not too strenuous.
  • Your neck may ache for up to 2 weeks after carotid endarterectomy.
  • You will take medicines and make healthy lifestyle changes.
  • A carotid procedure 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.footnote 2
  • Your arteries might become narrow again. You may still have a TIA or stroke.
  • All procedures have 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 a procedure Don't have a procedure
  • You take medicines and make healthy lifestyle changes to reduce your risk of stroke.
  • You avoid the risks of a procedure.
  • Medicine and lifestyle changes can lower your risk of TIA and stroke.
  • You may still have a TIA or stroke.
  • 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.footnote 5

Personal stories about carotid artery procedures

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 want to have a procedure. I'm seeing my doctor next week to talk about which procedure is best for me. 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 a procedure, but the closest major hospital is a couple hundred miles away, and I would rather not have a procedure 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. I don't want to have a procedure. And my doctor said medicine will help lower my risk of a stroke. So I'll take my medicine 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 a carotid procedure

Reasons not to have a carotid procedure

I feel that the benefits of a procedure are greater than the risks.

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

More important
Equally important
More important

I am confident that my doctor has the skill and experience to perform a successful procedure.

I'm not sure about my doctor's skill and experience with this procedure.

More important
Equally important
More important

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

I don't want to have a procedure for any reason.

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 a carotid artery procedure

NOT having a carotid artery procedure

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Are the benefits of a procedure 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 a procedure 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 a procedure 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 a procedure 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 a procedure 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 doctor at a hospital that has a good success rate with the procedure.
  • NoSorry, that's not right. It's important to find a skilled doctor at a hospital that has a good success rate with the procedure.
  • I'm not sureIt may help to go back and read "Get the Facts." It's important to find a skilled doctor at a hospital that has a good success rate with the procedure.
3.

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

  • YesYou're right. Medicines and healthy lifestyle changes can help lower your risk of stroke.
  • NoSorry, that's not right. Medicines and healthy lifestyle changes can help lower your risk of stroke.
  • I'm not sureIt may help to go back and read "Get the Facts." Medicines and healthy lifestyle changes can help lower your risk of stroke.

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

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

References
Citations
  1. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  2. Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
  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.
  5. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.
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 Prevention: Should I Have a Carotid Artery Procedure?

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 a carotid artery procedure to prevent a stroke.
  • Don't have a procedure. Keep taking medicines and making healthy lifestyle changes.

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). Having a carotid artery procedure—either carotid endarterectomy or carotid artery stenting—may help to prevent a TIA and stroke.
  • For some people, the medical facts make the choice pretty clear. A procedure is usually recommended if plaque is blocking nearly three-quarters of your artery (70% or more) and you've had a recent stroke or TIA. And it's usually not recommended if less than half (50%) of the artery is blocked.
  • The choice isn't as clear if you're in the middle—your arteries are between 50% and 70% blocked and you have had a recent stroke or TIA. It depends on your symptoms, your health, and your feelings about the risks and benefits.
  • If you have not had a TIA or stroke, medicines may work as well as a procedure to prevent a stroke.1
  • It's important that the benefits outweigh the risk of serious problems from a procedure.
  • Medicines and healthy lifestyle changes also can help lower your risk of stroke. Even if you have a procedure, you will also take medicine and make lifestyle changes.
FAQs

What are carotid artery procedures?

There are two kinds of carotid artery procedures: endarterectomy and stenting.

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.
  • Will close the artery and skin incisions with stitches.
Carotid artery stenting

Carotid artery stenting is similar to coronary angioplasty, which is done to open narrowed or blocked arteries in the heart.

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.

Stenting is not as common as carotid endarterectomy.

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

You may have tests to measure the amount of narrowing in your carotid arteries. These tests also help your doctor see how well blood flows through the area that is narrowed by plaque. These tests can help your doctor see what kind of plaque is blocking the artery and whether a procedure is a good choice.

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 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.

How well do carotid artery procedures work?

In people who have already had a TIA or stroke and who have moderate to severe narrowing (70% to 99%) of the carotid arteries, carotid endarterectomy reduces the risk of TIA and stroke.2

Carotid artery stenting may work as well as endarterectomy to prevent stroke in some people who have narrowed carotid arteries.3, 4

If you have not had a TIA or stroke, it is not as clear when a procedure might be a good choice. Medicine and lifestyle changes may work as well as a procedure to prevent a stroke. Your doctor might recommend a procedure if you have moderate to severe narrowing (more than 70%) and if the benefits of this procedure outweigh the risks.1

What are the risks of carotid artery procedures?

Risks of carotid procedures depend on your age, your health, and the skill and experience of the doctor. It's important to have these procedures done by a skilled doctor at a hospital that has a good success rate.

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

If you have had a TIA or stroke, a good success rate means complications happen in less than 6 out of 100 of these procedures. That means complications do not happen in more than 94 out of 100 of these procedures.5

If you have not had a TIA or stroke, it's important that you have a low risk of serious problems so that the benefits of a procedure outweigh the risks. Your doctor can help you know your risk. A low risk is less than 3%.1

Carotid endarterectomy

Risks of carotid endarterectomy include:

  • Infection.
  • Breathing problems.
  • Nerve injury.
  • Stroke, heart attack, and death.
Carotid artery stenting

Risks of carotid artery stenting include:

  • Infection.
  • Bleeding at the catheter insertion site.
  • Damage to the blood vessel at the catheter insertion site.
  • Stroke, heart attack, and death.

Who should not have a carotid artery procedure?

A carotid procedure is not advised for people who have:

  • TIAs that are caused by narrowed blood vessels in the back of the brain.
  • Severe coronary artery disease.
  • 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.

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.

What medicines and lifestyle changes help prevent stroke?

Medicine and healthy lifestyle changes help lower your risk of stroke. For some people, this is enough to lower their risk. If you have a carotid artery procedure, you will still need to take medicine and make lifestyle changes.

If you haven't already had a stroke or TIA, medicine may work just as well as a procedure to prevent a stroke.1

Medicines

Medicines that help prevent stroke include:

  • Aspirin or other blood thinners.
  • Blood pressure medicine.
  • Cholesterol medicine called statins.
Lifestyle changes

A healthy lifestyle can help prevent a stroke. This lifestyle includes:

  • Not smoking.
  • Eating heart-healthy foods.
  • Being active.
  • Staying at a healthy weight or losing weight if you need to.

Why might your doctor recommend a carotid artery procedure?

Your doctor may suggest that you have a procedure 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 procedure.
  • 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 a procedure Don't have a procedure
What is usually involved?
  • You will likely stay 1 or 2 nights in the hospital.
  • You can go back to your daily activities within a week or two, if they are not too strenuous.
  • Your neck may ache for up to 2 weeks after carotid endarterectomy.
  • You will take medicines and make healthy lifestyle changes.
  • You take medicines and make healthy lifestyle changes to reduce your risk of stroke.
What are the benefits?
  • A carotid procedure 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.2
  • You avoid the risks of a procedure.
  • Medicine and lifestyle changes can lower your risk of TIA and stroke.
What are the risks and side effects?
  • Your arteries might become narrow again. You may still have a TIA or stroke.
  • All procedures have 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.
  • 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.5

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 artery procedures

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 want to have a procedure. I'm seeing my doctor next week to talk about which procedure is best for me. 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 a procedure, but the closest major hospital is a couple hundred miles away, and I would rather not have a procedure 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. I don't want to have a procedure. And my doctor said medicine will help lower my risk of a stroke. So I'll take my medicine 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 a carotid procedure

Reasons not to have a carotid procedure

I feel that the benefits of a procedure are greater than the risks.

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

       
More important
Equally important
More important

I am confident that my doctor has the skill and experience to perform a successful procedure.

I'm not sure about my doctor's skill and experience with this procedure.

       
More important
Equally important
More important

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

I don't want to have a procedure for any reason.

       
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 a carotid artery procedure

NOT having a carotid artery procedure

       
Leaning toward
Undecided
Leaning toward

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

Check the facts

1. Are the benefits of a procedure 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 a procedure 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 a procedure 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 doctor at a hospital that has a good success rate with the procedure.

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

  • Yes
  • No
  • I'm not sure
You're right. Medicines and healthy lifestyle changes can help lower your risk of stroke.

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

References
Citations
  1. Meschia JF, et al. (2014). Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online October 28, 2014. DOI: 10.1161/STR.0000000000000046. Accessed October 29, 2014.
  2. Rerkasem K, Rothwell PM (2011). Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database of Systematic Reviews (4).
  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.
  5. Kernan WN, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45(7): 2160–2236. DOI: 10.1161/STR.0000000000000024. Accessed July 22, 2014.

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