 Carotid Artery DiseaseThe Vascular Surgery team at the University of Michigan consists of world class surgeons dedicated to providing exceptional patient care for carotid artery disease in our state-of-art U-M Cardiovascular Center (CVC). Our surgeons have extensive experience in the management of carotid artery disease and offer unique expertise in the two standards for treatment that exist today: For example, Dr. Ramon Berguer, M.D., Ph.D. has pioneered new surgical techniques that are used worldwide for the reconstruction of carotid and vertebral arteries impacted by advanced disease. And Dr. Enrique Criado, M.D. has developed a reverse flow stenting system that dramatically decreases the probability of embolization during stent placement.
Carotid Artery Disease Overview Carotid Artery Disease OverviewThe carotid arteries, large blood vessels on each side of the neck, carry oxygen-rich blood to the front structures in the brain that control thinking, speech, sensory and motor functions. At the back of the neck, another set of smaller arteries, the vertebral arteries, supply blood to the back of the brain. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. Diseases of these vessels are known collectively as cerebrovascular disease. 
The third-leading cause of death in the United States, cerebrovascular disease occurs when the blood vessels supplying the brain with oxygenated blood are damaged or their function is compromised. If blood flow is severely restricted due to a blockage or a rupture of a vessel, the brain does not receive adequate oxygen and a stroke can occur. In 2007, about 700,000 people suffered a new or recurrent stroke in the United States. What is Carotid Artery Disease?Carotid arteries are the vessels in the neck that carry blood from the heart and lungs to the head. These arteries, like others in the human body, can become thickened and lose their elasticity. Plaque builds up on the inside wall of the vessel, blocking blood flow to the brain. This condition, atherosclerosis, is often referred to as "hardening of the arteries." If this blockage is severe enough, it can cause symptoms such as: 
Another common symptom is a transient ischemic attack (TIA), which is sometimes called a ministroke. TIAs can cause temporary decreases in blood flow to parts of the brain, causing symptoms such as partial blindness, numbness and tingling of the skin, and weakness of an arm or a leg. TIAs usually last less than 30 minutes but can last up to 24 hours. People who have had a TIA are more likely to have a stroke. If untreated, a blocked carotid artery can also cause a stroke. Stroke is not only the third leading cause of death in the US, but can lead to permanent disability and a significantly altered lifestyle. With early diagnosis and appropriate treatment, the risk of stroke can be minimized. Risk factors for stroke include:
How is Carotid Artery Disease Diagnosed?It is important to tell your health care provider if you have had temporary problems with vision or minor paralysis. A routine physical exam usually detects carotid artery disease, even if you have no symptoms. Your provider may hear a murmur by listening to the carotid artery in your neck with a stethoscope. The murmur is caused by blood moving through a narrowed part of the artery. Tests you may have include:
How is Carotid Artery Disease Treated?Although there are a number of possible treatments for Carotid Artery Disease, the first step is testing. Screening for carotid disease is done easily and quickly with an ultrasound scan. There is no risk with this study and no discomfort. If you have any of the symptoms mentioned earlier, your doctor will most likely order this scan. Pending those results, your physician may suggest medication adjustments for your blood pressure or cholesterol level, and will certainly suggest you quit smoking, if you do. From the results of this screening, your physician will recommend a course of treatment. If you have some blockage of the artery but have no symptoms, you may be able to be treated with drugs. Your health care provider may prescribe medicine that thins the blood or prevents blood clots. You may also benefit from surgery. If you have symptoms, your doctor may order a cerebral arteriogram-an x-ray dye procedure that shows how narrow the inside of the artery is and the exact location of the blockage. If the plaque looks rough and irregular on the x-ray, your health care provider might recommend surgery because the irregular plaque might form clots, possibly causing a stroke. Surgical options include: What can I do to help prevent carotid artery disease?In almost all cases, atherosclerosis is the cause of carotid artery disease. You can help prevent atherosclerosis by following these guidelines:
Who is a good candidate for carotid endarterectomy?You are a good candidate for a carotid endarterectomy if you have severe narrowing of your carotid arteries, especially if you are experiencing TIAs and are otherwise in reasonably good health. List of University of Michigan Vascular Surgeons Who Perform Carotid EndarterectomyFor details about education, experience, and specialty in this clinical area, please visit these physician profile pages:
How do I prepare for a carotid endarterectomy?Your doctor will give you detailed instructions. These may include a suggestion to eat a light meal the night before the procedure and to not eat or drink anything after midnight before the procedure. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water. Follow your doctor's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery. How is the procedure performed?You will be given a general anesthetic to relax your muscles, put you in a deep sleep, and prevent you from feeling pain during the operation. Once the anesthesia takes effect, the medical team will shave the skin on your neck to help prevent infections. Your surgeon then makes a cut (incision) on one side of your neck to expose your blocked carotid artery. Then temporarily clamps will be put on your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck or through a temporary shunt inserted to detour the blood around the artery that is being repaired. After your surgeon clamps your carotid artery, he or she makes an incision directly into the blocked section. The plaque deposit it then peeled out by removing the inner lining of the diseased section of your artery. After removing the plaque, your surgeon stitches your artery closed, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Sometimes, a patch is used to widen the artery as part of the procedure. The patch material can be your own vein, usually from the leg, or a variety of synthetic materials depending on your specific case. What happens after the procedure?At first you will stay in an intensive care unit or special post-operation unit. When your condition is stable, you will be taken to a regular room. You may stay in the hospital 1 to 2 days, depending on your condition. You may need medicine that makes the blood less likely to clot after the surgery. Patients are often able to return to their normal activities in a few weeks. If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately. Because you had plaque in your artery, you should eat less fat and try to exercise more after you have recovered from the procedure. Ask your doctor what other steps you should take and when you should come back for a checkup. Are there any possible complications?As with any surgical procedure, you may have complications following a carotid endarterectomy. Although this risk is very low (from 1 and 3 percent), a stroke is one possible complication. Another uncommon complication is the development of another blockage in the same artery, called restenosis. This may occur later, especially if you continue to smoke, in approximately 2 to 3 percent of cases. Another unusual complication is temporary nerve injury, with symptoms that include hoarseness, difficulty swallowing or numbness in the face or tongue. This condition usually fades in less than 1 month and generally does not require any treatment. It is important to note that the chance of any of these complications is much less than the risk of stroke if a significant carotid blockage is not adequately treated. How can I take care of myself?Follow the treatment plan prescribed by your healthcare team and call your doctor right away if:
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