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.
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6Your Summary |
Is this decision for you? This could be a decision for you if you have carotid artery stenosis but have not had a stroke or TIA. If you have already had a stroke or TIA, this information is not for you.
Carotid artery stenosis is a narrowing of one or both of the carotid arteries, which supply blood to your brain. These arteries can be narrowed and damaged by plaque buildup (atherosclerosis). This plaque may limit blood flow to the brain. If this plaque breaks open, it may form a blood clot. Or pieces of the plaque may break off. A piece of plaque or a blood clot could move to the brain and cause a stroke.
There are two main ways to reduce the risk of stroke:
Having a procedure does not take the place of medicines and a healthy lifestyle. If you decide to have a procedure, it's still important to take your medicines and have healthy habits to reduce your stroke risk as much as possible.
Taking medicines and having a heart-healthy lifestyle are important for anyone who has narrowing in a carotid artery. These steps help control the conditions that increase your risk of stroke.
Medicines that can help reduce the risk of stroke include:
Healthy habits that can help reduce the risk of stroke include:
In people with carotid artery stenosis who take medicine and have healthy habits, about 1 out of 100 will have a stroke each year, and about 99 will not.footnote 6
Your stroke risk may be higher based on things like your age and health. Your doctor can help you understand your risk of stroke.
Two procedures that can help reduce the risk of stroke are carotid endarterectomy and carotid artery stenting. Endarterectomy is more common than stenting.
Carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is surgery to remove plaque buildup from a carotid artery. During this procedure, a surgeon:
Carotid artery stenting is also called carotid angioplasty. During this procedure, a doctor:
A carotid procedure may lower the risk of stroke from about 2% per year to 1% per year.footnote 2 footnote 3
Overall, endarterectomy and stenting seem to work about equally well to help prevent stroke.footnote 5
It is not clear that a procedure will reduce stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with endarterectomy and stenting.
Having a carotid artery procedure may help prevent a stroke in the long term. But in the short term, it increases the risk of stroke and death.
The risk of problems is highest shortly after the procedure is done. The risk decreases over time. In the first 30 days after a procedure, up to about 3 in 100 people have a stroke or die. That means about 97 out of 100 people do not have a stroke or die.footnote 5
Endarterectomy and stenting have similar rates of risk. But carotid stenting is linked with a higher risk of stroke in people older than 70.footnote 5
Other risks of carotid endarterectomy include:
Other risks of carotid artery stenting include:
Your chance of having a problem can depend on things like your age and your overall health. Your doctor can help you understand your risk of problems from a procedure. It is also important to find a surgeon and a hospital that are experienced in doing the procedure and have a low rate of serious problems.footnote 1 footnote 4
Your doctor may recommend tests such as a carotid angiogram, a carotid ultrasound, or a magnetic resonance angiogram (MRA). These tests can help your doctor:
A doctor may suggest a procedure if it seems likely that the benefits of a procedure will outweigh the risks. To decide if this is the case, a doctor will check several things, including:footnote 1
A doctor may give you the option of having a procedure, but this is not a clear-cut decision. It is also not one you have to make in a hurry. You can take time to weigh your choices and decide what feels right for you. How you feel about the risks and benefits is just as important as the medical facts.
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What are the benefits? |
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What are the risks and side effects? |
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These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
It worries me that one of my carotid arteries is almost 90% narrowed. I don't have any serious health problems, so my doctor said that I am healthy enough to have a procedure. I know a procedure has risks but think I want to have one.
David, age 76
I have narrowing in one of my arteries. My doctor says I could have a procedure, but why would I choose a treatment that would make me more likely to have a stroke in the short term? That doesn't make sense to me. I'll stick with staying healthy by taking my medicines and exercising.
Charlene, age 68
I really worry about having a stroke. I understand that a procedure might cause a stroke. But I'm willing to take a risk now to reduce my chance of stroke later in life.
Roberto, age 67
My carotid arteries are about 75% narrowed, but otherwise I'm in pretty good health. I take my medicines the way I'm supposed to, and they help lower my risk of stroke. My doctor says this isn't an urgent decision, so for now I'm not going to have a procedure. And I'll think carefully about whether it's something I might want to have later.
Golda, age 71
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 accept that a procedure has serious risks.
I want to avoid the serious risks of a procedure.
I want to do everything possible to try to lower my risk of stroke.
I want to lower my risk of stroke with medicines and healthy habits alone.
My other important reasons:
My other important reasons:
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
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Author | Healthwise Staff |
---|---|
Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
Primary Medical Reviewer | Adam Husney MD - Family Medicine |
Primary Medical Reviewer | Martin J. Gabica MD - Family Medicine |
Primary Medical Reviewer | Robert A. Kloner MD, PhD - Cardiology |
Primary Medical Reviewer | Caroline S. Rhoads MD - Internal Medicine |
Is this decision for you? This could be a decision for you if you have carotid artery stenosis but have not had a stroke or TIA. If you have already had a stroke or TIA, this information is not for you.
Carotid artery stenosis is a narrowing of one or both of the carotid arteries, which supply blood to your brain. These arteries can be narrowed and damaged by plaque buildup (atherosclerosis). This plaque may limit blood flow to the brain. If this plaque breaks open, it may form a blood clot. Or pieces of the plaque may break off. A piece of plaque or a blood clot could move to the brain and cause a stroke.
There are two main ways to reduce the risk of stroke:
Having a procedure does not take the place of medicines and a healthy lifestyle. If you decide to have a procedure, it's still important to take your medicines and have healthy habits to reduce your stroke risk as much as possible.
Taking medicines and having a heart-healthy lifestyle are important for anyone who has narrowing in a carotid artery. These steps help control the conditions that increase your risk of stroke.
Medicines that can help reduce the risk of stroke include:
Healthy habits that can help reduce the risk of stroke include:
In people with carotid artery stenosis who take medicine and have healthy habits, about 1 out of 100 will have a stroke each year, and about 99 will not.6
Your stroke risk may be higher based on things like your age and health. Your doctor can help you understand your risk of stroke.
Two procedures that can help reduce the risk of stroke are carotid endarterectomy and carotid artery stenting. Endarterectomy is more common than stenting.
Carotid endarterectomy (say "kuh-RAW-tid en-dar-tuh-REK-tuh-mee") is surgery to remove plaque buildup from a carotid artery. During this procedure, a surgeon:
Carotid artery stenting is also called carotid angioplasty. During this procedure, a doctor:
A carotid procedure may lower the risk of stroke from about 2% per year to 1% per year.2 3
Overall, endarterectomy and stenting seem to work about equally well to help prevent stroke.5
It is not clear that a procedure will reduce stroke risk more than medicines and lifestyle changes alone. Studies are being done to compare current medical therapy with endarterectomy and stenting.
Having a carotid artery procedure may help prevent a stroke in the long term. But in the short term, it increases the risk of stroke and death.
The risk of problems is highest shortly after the procedure is done. The risk decreases over time. In the first 30 days after a procedure, up to about 3 in 100 people have a stroke or die. That means about 97 out of 100 people do not have a stroke or die.5
Endarterectomy and stenting have similar rates of risk. But carotid stenting is linked with a higher risk of stroke in people older than 70.5
Other risks of carotid endarterectomy include:
Other risks of carotid artery stenting include:
Your chance of having a problem can depend on things like your age and your overall health. Your doctor can help you understand your risk of problems from a procedure. It is also important to find a surgeon and a hospital that are experienced in doing the procedure and have a low rate of serious problems.1 4
Your doctor may recommend tests such as a carotid angiogram, a carotid ultrasound, or a magnetic resonance angiogram (MRA). These tests can help your doctor:
A doctor may suggest a procedure if it seems likely that the benefits of a procedure will outweigh the risks. To decide if this is the case, a doctor will check several things, including:1
A doctor may give you the option of having a procedure, but this is not a clear-cut decision. It is also not one you have to make in a hurry. You can take time to weigh your choices and decide what feels right for you. How you feel about the risks and benefits is just as important as the medical facts.
Have a procedure | Don't have a procedure | |
---|---|---|
What is usually involved? |
|
|
What are the benefits? |
|
|
What are the risks and side effects? |
|
|
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"It worries me that one of my carotid arteries is almost 90% narrowed. I don't have any serious health problems, so my doctor said that I am healthy enough to have a procedure. I know a procedure has risks but think I want to have one."
— David, age 76
"I have narrowing in one of my arteries. My doctor says I could have a procedure, but why would I choose a treatment that would make me more likely to have a stroke in the short term? That doesn't make sense to me. I'll stick with staying healthy by taking my medicines and exercising."
— Charlene, age 68
"I really worry about having a stroke. I understand that a procedure might cause a stroke. But I'm willing to take a risk now to reduce my chance of stroke later in life."
— Roberto, age 67
"My carotid arteries are about 75% narrowed, but otherwise I'm in pretty good health. I take my medicines the way I'm supposed to, and they help lower my risk of stroke. My doctor says this isn't an urgent decision, so for now I'm not going to have a procedure. And I'll think carefully about whether it's something I might want to have later."
— Golda, age 71
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 accept that a procedure has serious risks.
I want to avoid the serious risks of a procedure.
I want to do everything possible to try to lower my risk of stroke.
I want to lower my risk of stroke with medicines and healthy habits alone.
My other important reasons:
My other important reasons:
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
1. Is this procedure an option for people with only a small amount of narrowing in their carotid arteries?
2. Will having a procedure lower your stroke risk right away?
3. If you decide to have a procedure, will you be able to stop taking medicines that help prevent stroke?
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
By | Healthwise Staff |
---|---|
Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
Primary Medical Reviewer | Adam Husney MD - Family Medicine |
Primary Medical Reviewer | Martin J. Gabica MD - Family Medicine |
Primary Medical Reviewer | Robert A. Kloner MD, PhD - Cardiology |
Primary Medical Reviewer | Caroline S. Rhoads MD - Internal Medicine |
Current as of: January 10, 2022
Author: Healthwise Staff
Medical Review:E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Martin J. Gabica MD - Family Medicine & Robert A. Kloner MD, PhD - Cardiology & Caroline S. Rhoads MD - Internal Medicine
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