Carotid endarterectomy and carotid angioplasty and stenting are in-hospital procedures used to treat severe carotid artery disease, narrowing of the arteries in the neck that carry blood to the brain. If blood flow to brain tissue is reduced or cut off, brain tissue can begin to die, resulting in a stroke. Stroke is a significant cause of death and disability in the United States.

Carotid endarterectomy and carotid angioplasty and stenting are each highly effective treatments for preventing a first or recurrent stroke. So how, then, does your physician recommend one treatment or the other?

Your doctor’s recommendation will be based on a number of factors, including your medical history, risk of complications, and the location and severity of the blockages in the carotid arteries. Your treatment will be individualized, and another patient may not be given the same treatment recommendations.

Generally speaking:

• Patients who have a blockage of less than 50 percent in a carotid artery will be treated with medication and lifestyle changes only.
• Patients with a blockage of 50–69 percent may be recommended for either carotid endarterectomy or carotid angioplasty and stenting depending on other risk factors and how severe the blockage is within that percentage range.
• In cases where a blockage is 70 percent or higher, treatment by either carotid endarterectomy or carotid angioplasty and stenting will be recommended.
• Carotid endarterectomy has a well-proven track record and has been used with good results for over 50 years.
• Carotid angioplasty and stenting is a minimally invasive procedure (requiring only a puncture site in the skin for a thin tube called a catheter rather than a surgical incision) and has a shorter recovery, and is thus often recommended for patients who are at higher risk. Someone may qualify as high risk, for example, if he or she is older, has coexisting heart disease, of if the location of the blockage makes angioplasty and stenting more appropriate.

Carotid Angioplasty and Stenting or Carotid Endarterectomy? Questions to Ask Your Doctor

Use the following questions as a tool to help you talk to your physician about the best treatment for your carotid artery disease. Print them out and take them with you to your next appointment. Take notes to help you remember your discussion when you get home.

• How severe are the blockages in my carotid arteries? Can I be treated with medication and lifestyle changes, or do I require an in-hospital surgery or procedure?
• Do you recommend carotid endarterectomy or carotid angioplasty and stenting for me? Why did you choose one treatment over the other?
• What medical centers near me specialize in endarterectomy or  stenting?
• Am I a high-risk patient? Is there anything in my risk factors or medical history that might make me high risk?
• What will happen if my carotid arteries re-narrow after I have been treated with surgery or a minimally invasive procedure?

 Learn More

Read here about the causes and risk factors underlying development of carotid artery disease. Your risk factors will influence which in-hospital treatment, carotid endarterectomy or carotid angioplasty and stenting, your physician thinks is right for you.