Managing carotid artery disease is a lifelong process. If you’ve been diagnosed with carotid artery disease, your doctor can recommend an individualized treatment plan based on the degree of narrowing in your arteries and your age, among other factors. Your treatment may include lifestyle changes, medications, procedures such as carotid angioplasty and stenting, and carotid endarterectomy.
If you’ve been diagnosed with carotid artery disease, the disease process that causes most strokes, lifestyle changes are an important part of your treatment, even if you’ve had a procedure to restore blood flow to your brain. Lifestyle changes can be difficult, but they are well worth the effort. Making positive changes in diet, exercise, and personal outlook can have measurable beneficial effects on risk factors such as high blood pressure, cholesterol, and body weight. Reductions in any of these risk factors can help control carotid artery disease and lower your risk of having a stroke. If you’ve already had a stroke or a procedure such as carotid artery angioplasty and stenting or carotid endarterectomy, lifestyle changes can help your recovery and prevent future problems.
Stop smoking – The toxins in cigarette smoke damage artery walls throughout the body, including the carotid arteries. This damage leads directly to atherosclerosis or the "hardening of the arteries." Quitting smoking can slow the progression of carotid artery disease.
Adopt a heart-healthy diet – A diet low in saturated fats can reduce cholesterol buildup and the narrowing of the carotid arteries. A healthier diet can also help control other risk factors for carotid artery disease, such as obesity and high blood pressure.
Limit your alcohol intake – Alcohol consumption contributes to two risk factors for carotid artery disease: high blood pressure and obesity. For good overall health, including healthy carotid arteries, males (assigned at birth) should limit alcohol consumption to one to two drinks a day, and females (assigned at birth) should limit themselves to one drink per day. (One drink is 12 fluid ounces of regular beer, 5 fluid ounces of wine, or 1.5 fluid ounces of 80-proof distilled spirits.)
Exercise or be physically active – Doing good for your carotid arteries does not require becoming a triathlete. The path to improved wellness can be as simple as 30 minutes of moderate exercise daily. This can be walking, biking, doing house or lawn work, or whatever gets you moving. You and your doctor can discuss what exercise level might be suitable and enjoyable for you.
Lose weight – Weight gain can substantially elevate your risk of stroke. Work with your physician to ensure you're at a healthy weight; it helps control blood cholesterol levels and blood pressure.
Monitor your blood pressure – If you have high blood pressure (hypertension), your blood moves through the arteries with more force and stress against the inside of the artery walls. This can damage the arteries leading to the brain and throughout the body. Monitoring your blood pressure is important to protecting the health of your arteries. Blood pressure readings are recorded with two numbers, one over the other, as a ratio. A normal blood pressure reading should be less than 120 over 80 mm Hg.
Reduce stress – A diagnosis of carotid artery disease can be stressful, but that stress response can further harm your arteries. Stress contributes to high blood pressure and atherosclerosis. Your plan for prevention or recovery should include measures to reduce stress.
The goals of treating carotid artery disease with medications are to reduce plaque buildup in your carotid arteries and blood vessels throughout your body and reduce the likelihood that a blood clot will form elsewhere in your body and travel to a blood clot vessel in your brain that would cause a stroke.
Medications for carotid artery disease primarily consist of the following, along with medications to help control high blood pressure and other cardiovascular risk factors:
- Antiplatelet medications – If you’re at risk of a first or recurrent stroke, your doctor will likely recommend that you take an antiplatelet medication, which helps to prevent excessive clotting. Platelets are cell proteins that circulate in the blood and have a role in blood clot formation. Blood clotting is important for wound healing, but blood clots can be deadly if they form or lodge in blood vessels and block blood flow to the heart, lungs, or brain. The most common antiplatelet medication that is prescribed is aspirin. Other antiplatelet medications, including clopidogrel (Plavix) or dipyridamole (Persantine), may be prescribed.
- Anticoagulant medications – These “blood thinners” slow down blood clotting by blocking the steps necessary to create a clot. If you have carotid artery disease, a common anticoagulant that is prescribed is warfarin (Coumadin). Warfarin therapy requires frequent monitoring using blood tests to achieve the right amount of anticoagulation. Other oral anticoagulants are also available, some of which do not require frequent blood tests.
- Tissue plasminogen activator (tPA) – tPA is a blood-clot-dissolving medication used to treat an ischemic stroke that is in progress. Patients who receive tPA within the first three hours after their first stroke symptoms seem to have a better chance of recovering and fewer complications. Unfortunately, few patients with an ischemic stroke receive this treatment because they either don’t make it to the hospital within that three-hour window during which the treatment is effective, or they’re not diagnosed quickly enough after they arrive.
For the medication to be effective, it has to be taken exactly as prescribed by your treating doctor. If you have difficulty remembering to take your medication or have concerns about side effects or expenses, discuss these concerns with your doctor. Don’t stop taking medication alone without consulting your doctor, as doing so can be dangerous.
Carotid angioplasty and stenting
If diagnostic tests have revealed a severe blockage in a carotid artery that can be treated without surgery, you may be treated with carotid angioplasty and stenting. The procedure is performed by a doctor with special training in catheter-based therapies, such as an interventional cardiologist, interventional radiologist, or interventional vascular surgeon. Carotid angioplasty and stenting work by reopening a blockage in the carotid arteries through a thin tube called a catheter and then propping the affected artery open with a mesh tube called a stent.
A carotid endarterectomy is a well-proven treatment for carotid artery disease and has been performed successfully for over 50 years. It can be an important therapy in preventing a first or recurrent stroke. During the surgery, artery-clogging plaque is removed from narrowed or blocked carotid arteries after making an incision to open up the vessels to restore blood flow.