Large scientific studies have established the effectiveness of carotid artery surgery in reducing the risk of stroke over time. In most cases patients are best treated with open surgery to remove the buildup of calcium, cholesterol, and cells that can come loose and travel to the brain. The stroke rate within 30 days of surgery has been 0.3% (or 1 in 300) in our last 1700 carotid endarterectomies. These results are better than published standards for the procedure.
Carotid stenting is another procedure that may be equal to surgery in certain high-risk patients, such as those with severe heart or lung disease, or patients with recurrent narrowing after prior surgery. Before consideration of stent placement, patients should have an angiogram to determine the suitability of their anatomy. We have performed carotid stenting when surgery appears to carry a greater risk than usual. The most recent large scale clinical trials comparing stenting to endarterectomy show a 2% risk of stroke with endarterectomy versus 4% with stenting while endarterectomy carries a 2% risk of heart attack versus 1% risk with stenting.