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Carotid Stenosis

Carotid stenosis is a narrowing of the carotid arteries, the two large arteries responsible for carrying oxygen-rich blood to the brain. The narrowing is caused by a buildup of atherosclerotic plaque in the arteries. When the blockage prevents blood from reaching parts of the brain, causing shortages of oxygen, it can result in transient ischemic attacks (TIAs) or a stroke. Clots that may form on narrowing portions of the arteries can break off and also cause TIAs or stroke.

Figure showing blocked section of carotid artery
illustration courtesy of the American Heart Association and American Stroke Association

The Barnes-Jewish Hospital Stroke and Cerebrovascular Center is the first in Missouri—and one of the first in the United States — to be designated a Comprehensive Stroke Center by the Joint Commission and the American Heart Association/American Stroke Association. This certification is awarded to hospitals that achieve higher standards and meet specific criteria for resources, staff and training that are essential to treat the most complex stroke cases.

In the Center, a multidisciplinary team coordinates treatments for carotid stenosis. The team includes Washington University cerebrovascular surgeons, neurologists, and neuro-radiologists.

For more information about the strict criteria to be designated a Comprehensive Stroke Center, see Barnes-Jewish & Washington University Stroke Center.


Treatments

There are two primary options for the treatment of carotid stenosis:

Carotid endarterectomy: This is a surgical procedure to remove fatty deposits (plaque) that are narrowing the arteries in your neck. It is the standard treatment for severe buildup of plaque in the carotid artery.During this procedure, the surgeon

  • makes a small cut in the patient’s neck at the spot where the artery is blocked or narrowed
  • opens up the narrowed artery and removes the plaque
  • make the artery as smooth and clean as possible
  • closes up the artery and the cut

Surgery usually lasts about 1-2 hours. Patients are generally able to return to work within a month, but should make healthy lifestyle changes to reduce the chance of further plaque deposits and to lower the risk of stroke.

Carotid Stenting: Stenting is often recommended for people who are unable to undergo an endarterectomy. (e.g. for people who can't tolerate the side effects of anesthesia).  A stent is a slender metal-mesh tube that is placed inside an artery to keep the artery open. Carotid stenting is a treatment that offers an effective means of re-establishing blood flow through blocked carotid arteries and is part of a stroke prevention strategy.

The goal of carotid stenting is the restoration of adequate blood flow (revascularization) through the affected part of the body by enlarging the blood vessel from within.

Conferences

Weekly Cerebrovascular Conference

Fridays, 8-9 a.m. This multidisciplinary conference includes vascular neurosurgeons, interventional neuroradiologists and stroke neurologists.

Physicians wishing to submit cases for review should contact the Cerebrovascular Nurse Coordinator at 314-747-8871. 

Evidence-based Management of Cerebrovascular Disease Series

Tuesdays, noon. These ongoing presentations are held in the Lower Level West Pavilion Auditorium of Barnes-Jewish Hospital.

Annual Brain Attack Conference

This conference is held annually for emergency medicine physicians, neurologists, neurosurgeons, primary care physicians, internists, neuroscience and emergency medicine nurses, EMS providers, hospital administrators and other health professionals who want to enhance their knowledge of the management of patients with cerebrovascular diseases. More information on next Brain Attack conference.

Faculty

Neurosurgery Providers - Cerebrovascular Surgeons

Interventional Neuroradiology Providers

  • DeWitte T. Cross, MD
  • Colin P. Derdeyn, MD
  • Christopher J. Moran, MD

Vascular Neurology Providers

  • David A. Carpenter, MD
  • Andria L. Ford
  • Jin-Moo Lee, MD, PhD

Critical Care Neurology Providers

  • Rajat Dhar, MD
  • Michael Diringer, MD
  • Salah G. Keyrouz, MD
  • Terrance Kummer, MD, PhD

Neuro-Rehabilitation Providers

  • Alex Carter, MD
  • Maurizio Corbetta, MD
  • Robert Fucetola, PhD
  • Thy Huskey, MD

 



Highlights

We have a policy of urgent treatment for all patients with symptomatic carotid artery stenosis (carotid stenting or carotid endarterectomy) within 24 hours of diagnosis.