Treatment for carotid artery disease depends on the severity of the blockage in the blood vessel. Over time, physicians have developed standards to help them choose between treatment with medication, surgery or a less-invasive procedure. In general, patients may be treated with medication and no surgical intervention if:

For people in these categories, the first step in their treatment will likely begin with controlling risk factors. The controllable risk factors for carotid artery disease are similar to those for coronary artery disease, and the lifestyle changes are the same for both conditions. These include:

• Quitting smoking. Smoking is a major cause of coronary artery disease and cardiac arrest. Heart disease is the leading smoking-related cause of death in the United States among men and women, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC also suggests that the average smoker dies nearly seven years before a nonsmoker.
  
  
• Maintaining a regular program of exercise. The increased risk from not exercising has been compared to the risk from smoking a pack of cigarettes per day.
  
  
• Reducing cholesterol levels. A key strategy for reducing cholesterol levels is to eat a heart-healthy diet that includes reducing intake of certain fats and oils. Saturated fats increase cholesterol levels. In addition to making diet changes, people are encouraged to exercise regularly. If these strategies do not reduce cholesterol levels, a physician may prescribe cholesterol-reducing drugs.
  
  
• Controlling diabetes. Persons with diabetes may be more likely to develop heart-related diseases. Preventive care is crucial to the overall health and heart function of diabetic patients.
  
  
• Controlling high blood pressure (hypertension). Individuals with high blood pressure are at greater risk of cardiovascular problems resulting from coronary artery disease. High blood pressure is also the most common risk factor for stroke. This is because a buildup of plaque in the arteries can lead to an even greater increase in blood pressure in the damaged areas of those arteries. Hypertension can be controlled through taking blood pressure medications (antihypertensives), eating a heart-healthy, low-salt diet and engaging in regular exercise. People are also encouraged to self-monitor their blood pressure and have regular check-ups with their physician.
  
  
• Learning and practicing stress management techniques. Stress can lead to high-risk situations such as overeating, smoking, high blood pressure and a lack of exercise. In addition, chronic stress may be a direct contributor to poor heart health because it produces increases in blood pressure that could become permanent.

In addition to making lifestyle changes, medications may be prescribed to reduce the risk of stroke. These medications include a daily dose (usually 81 to 325 milligrams) of aspirin or other antiplatelet or anticoagulant drugs to help prevent the formation of blood clots. 

Research has also shown that statins, which are used to lower cholesterol levels, can help prevent stroke. Although their mechanism of action is not completely understood, researchers believe that statins offer some protection through their ability to stabilize plaque deposits, reduce inflammation and slow the progression of carotid arterial disease. Another class of drugs called ACE inhibitors has also been shown to reduce the risk of stroke and heart attack in high-risk patients. Individuals should always consult with their physician before taking any medication or supplement, including  those available over-the-counter.

If lifestyle changes and/or medication are not enough to treat the disease, physicians may recommend either surgery (carotid endarterectomy) or a less-invasive procedure such as angioplasty and stenting. The type of treatment recommended depends on a variety of factors. During a carotid endarterectomy, the patient is usually put under general anesthesia while surgery on the arteries in the neck is performed. Blood flow is temporarily re-routed through a tube and around the blockage in the carotid artery. The obstructing plaque along the wall of the artery is removed resulting in an open artery for maximum blood flow. The tube is removed, and the surgery is complete.

Although research consistently supports the use of an endarterectomy to reduce the risk of having a stroke, the surgery itself carries a risk of stroke and other possible complications. Patients are encouraged discuss the benefits and risks of this procedure with their physicians before undergoing an endarterectomy.

Some patients may also be candidates for a less-invasive procedure known as carotid artery (or angioplasty) stenting. The U.S. Food and Drug Administration (FDA) approved this procedure for use among certain patients in 2004. During this procedure, a catheter is inserted into a blood vessel (usually the femoral artery in the groin) and fed all the way up to the blocked carotid artery. A balloon at the tip of the catheter is then briefly inflated, which presses plaque back against the wall of the artery and makes more room for the blood to flow. Immediately after the balloon angioplasty, a wire mesh metal tube stent is inserted through the catheter and into the artery, where it expands to hold open the artery. A stent becomes a permanent part of the artery’s tissue in a matter of months. The long-term effects of this procedure are still being studied but it is a good alternative for patients who are not good candidates for endarterectomy.

Like endarterectomy, there is a risk that pieces of plaque will break off during the procedure itself and possibly cause a stroke. To prevent this, carotid artery stent systems are designed with special baskets that are temporarily deployed in the blood vessel during the procedure. These baskets are designed to catch any tiny particles of plaque that may break off during the procedure. Research has shown that carotid artery stenting has roughly the same rate of complications as endarterectomy, and may be safer than surgery in high risk patients. .

It  is unclear  if surgery or stenting is better for patients with carotid artery disease. There have been three well-designed trials comparing the two treatments. The first showed that stenting was better for patients who have high risk features - typically severe heart or lung disease. The second trial found that surgery and stenting had similar results in patients who did not have high risk features and the third found that surgery was more effective than stenting in patients who did not have high risk features. Larger trials are ongoing.

The strategies for preventing carotid artery disease include the same lifestyle changes recommended in the treatment of the disease. For patients at high risk of developing the disease, physicians may perform carotid duplex imaging (Doppler ultrasound of the carotid arteries) as part of the patients’ regular examinations to screen for the disease.