August 21, 2019 – Medical Therapy

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Anchor lead: Treatment of blockages in the arteries of the neck may start with medication, Elizabeth Tracey reports

You’ve just been told you have a blockage in your carotid artery going to your head, and you’re at increased risk for stroke. Chris Abularrage, a vascular surgeon at Johns Hopkins, says surgery may be needed but treatment should most often start first with medications.

Abularrage: As soon as you identify carotid stenosis, the first thing you want to do is get medical management on board. So you start them on antiplatelet therapy and statin therapy as statin therapy stabilizes plaque. That effect is completely separate from its cholesterol lowering effects. I tell my patients I don’t really care what your cholesterol is I just want to make sure that you’re on a statin and some sort of antiplatelet before we really consider doing anything else.  Whether they just have mild carotid stenosis or severe carotid stenosis and they’re going to need some sort of surgery.  :27

Surgery may involve removing plaque from the artery directly or placing a stent, a type of scaffold to hold the vessel open, with the newest approach making an incision directly in the neck to do so. Abularrage says your surgeon can help you determine which is best for you. At Johns Hopkins, I’m Elizabeth Tracey.