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How Is Carotid Artery Disease Treated?

Treatments for carotid artery disease may include lifestyle changes, medicines, and medical procedures. The goals of treatment are to stop the disease from getting worse and to prevent a stroke.

Your treatment will depend on your symptoms, how severe the disease is, and your age and overall health.

Lifestyle Changes

Making lifestyle changes can help prevent carotid artery disease or keep it from getting worse. For some people, these changes may be the only treatment needed:

  • Follow a healthy diet to prevent or lower high blood pressure and high blood cholesterol and to maintain a healthy weight.
  • Be physically active. Check with your doctor first to find out how much and what kinds of activity are safe for you.
  • If you're overweight or obese, lose weight.
  • If you smoke, quit. Also, try to avoid secondhand smoke.

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight.

For information about healthy eating, go to the National Heart, Lung, and Blood Institute's (NHLBI's) Aim for a Healthy Weight Web site. This site provides practical tips on healthy eating, physical activity, and controlling your weight.

Therapeutic Lifestyle Changes (TLC). Your doctor may recommend a three-part program called TLC if you have high blood cholesterol. TLC includes a healthy diet, physical activity, and weight management.

With the TLC diet, less than 7 percent of your daily calories should come from saturated fat. This kind of fat is found mainly in meat, poultry, and dairy products. No more than 25 to 35 percent of your daily calories should come from all fats, including saturated, trans, monounsaturated, and polyunsaturated fats.

You also should have less than 200 mg a day of cholesterol. The amounts of cholesterol and the different kinds of fat in prepared foods can be found on the foods' Nutrition Facts labels.

Foods high in soluble fiber also are part of a healthy diet. They help block the digestive tract from absorbing cholesterol. These foods include:

  • Whole-grain cereals such as oatmeal and oat bran
  • Fruits such as apples, bananas, oranges, pears, and prunes
  • Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima beans

A diet rich in fruits and vegetables can increase important cholesterol-lowering compounds in your diet. These compounds, called plant stanols or sterols, work like soluble fiber.

Fish are an important part of a healthy diet. They're a good source of omega-3 fatty acids, which help lower blood cholesterol levels. Try to have about two fish meals every week. Fish high in omega-3 fatty acids are salmon, tuna (canned or fresh), and mackerel.

You also should try to limit the amount of sodium (salt) that you eat. Too much sodium can raise your risk of high blood pressure. Choose low-sodium and "no added salt" foods and seasonings at the table or when cooking. The Nutrition Facts label on food packaging shows the amount of sodium in an item.

Try to limit drinks with alcohol. Too much alcohol will raise your blood pressure and triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds extra calories, which will cause weight gain.

Men should have no more than two drinks containing alcohol a day. Women should have no more than one drink containing alcohol a day. One drink is a glass of wine, beer, or a small amount of hard liquor.

For more information about TLC, go to the NHLBI's “Your Guide to Lowering Your Cholesterol With TLC.”

Dietary Approaches to Stop Hypertension (DASH). Your doctor may recommend the DASH eating plan if you have high blood pressure. The DASH eating plan focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and low in fat, cholesterol, and sodium.

DASH also focuses on fat-free or low-fat milk and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meats (including lean red meats), sweets, added sugars, and sugar-containing beverages. It's rich in nutrients, protein, and fiber.

The DASH eating plan is a good healthy eating plan, even for those who don't have high blood pressure. For more information, go to the NHLBI's "Your Guide to Lowering Your Blood Pressure With DASH."

Be Physically Active

Regular physical activity can lower many carotid artery disease risk factors, including LDL ("bad") cholesterol, high blood pressure, and excess weight.

Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. HDL cholesterol is the “good” cholesterol that helps prevent plaque buildup.

Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. The more active you are, the more you will benefit.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Although the Health Topics article and “Your Guide” booklet focus on heart health, they include information that applies to general health and well-being.

Maintain a Healthy Weight

Maintaining a healthy weight can lower your risk for carotid artery disease and stroke. Even a modest weight gain can increase your risk of having a stroke.

If you're overweight, aim to reduce your weight by 7 to 10 percent during your first year of treatment. This amount of weight loss can lower your risk for carotid artery disease and other health problems.

After the first year, you may have to continue to lose weight so you can lower your body mass index (BMI) to less than 25.

BMI measures your weight in relation to your height. A BMI between 25 and 29.9 is considered overweight for adults. A BMI of 30 or more is considered obese for adults. A BMI of less than 25 is the goal for preventing and treating carotid artery disease.

You can measure your BMI using the NHLBI's online calculator, or your health care provider can measure your BMI.

For more information about losing weight or maintaining a healthy weight, go to the Health Topics Overweight and Obesity article.

Quit Smoking

If you smoke or use tobacco, quit. Smoking can damage your arteries and raise your risk for stroke and other health problems. Also, try to avoid secondhand smoke.

Talk with your doctor about programs and products that can help you quit. For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart." Although these resources focus on heart health, they include general information about how to quit smoking.

The U.S. Department of Health and Human Services also has information about how to quit smoking.

Medicines

You may need medicines to treat diseases and conditions that damage the carotid arteries. High blood pressure, high blood cholesterol, and diabetes can worsen carotid artery disease.

Some people can control these risk factors with lifestyle changes. Others also need medicines to achieve and maintain control.

You may need anticlotting medicines to prevent blood clots from forming in your carotid arteries and causing a stroke. Damage and plaque buildup make blood clots more likely.

Aspirin and clopidogrel are two common anticlotting medicines. They stop platelets from clumping together to form clots. These medicines are a mainstay of treatment for people who have known carotid artery disease.

Your health care team will help find a treatment plan that's right for you. Sticking to this plan will help avoid further harm to your carotid arteries.

If you have a stroke due to a blood clot, you may be given a clot-dissolving, or clot-busting, medicine. This type of medicine must be given within 4 hours of symptom onset.

The sooner treatment occurs, the better your chances of recovery. Thus, it's important to know the signs and symptoms of a stroke and call 9–1–1 right away for emergency care.

Medical Procedures

You may need a medical procedure to treat carotid artery disease. Doctors use one of two methods to open narrowed or blocked carotid arteries: carotid endarterectomy (END-ar-ter-EK-to-me) and carotid artery angioplasty and stenting.

Carotid Endarterectomy

Carotid endarterectomy is mainly for people whose carotid arteries are blocked 50 percent or more.

For the procedure, a surgeon will make a cut in your neck to reach the narrowed or blocked carotid artery. Next, your surgeon will make a cut in the blocked part of the artery and remove the artery's inner lining.

Finally, your surgeon will close the artery with stitches and stop any bleeding. He or she will then close the cut in your neck.

Carotid Endarterectomy

The illustration shows a cross-section of a healthy heart and its inside structures. The blue arrow shows the direction in which oxygen-poor blood flows from the body to the lungs. The red arrow shows the direction in which oxygen-rich blood flows from the lungs to the rest of the body.

The illustration shows the process of carotid endarterectomy. Figure A shows a carotid artery that has plaque buildup. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows how the carotid artery is cut and the plaque removed. Figure C shows the artery stitched up and normal blood flow restored. The inset image shows a cross-section of the artery with plaque removed and normal blood flow restored.

Carotid Artery Angioplasty and Stenting

Doctors use a procedure called angioplasty (AN-jee-oh-plas-tee) to widen the carotid arteries and restore blood flow to the brain.

A thin tube with a deflated balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery.

A stent (a small mesh tube) is then put in the artery to support the inner artery wall. The stent also helps prevent the artery from becoming narrowed or blocked again.

Carotid Artery Stenting

Figure A shows the structure and blood flow in the interior of a normal heart. Figure B shows two common locations for a ventricular septal defect. The defect allows oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle.

The illustration shows the process of carotid artery stenting. Figure A shows an internal carotid artery that has plaque buildup and reduced blood flow. The inset image shows a cross-section of the narrowed carotid artery. Figure B shows a stent being placed in the carotid artery to support the inner artery wall and keep the artery open. Figure C shows normal blood flow restored in the stent-widened artery. The inset image shows a cross-section of the stent-widened artery.

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November 1, 2010