Treatment options for cerebrovascular disease depend on the nature and severity of the disease. The goal with hemorrhagic disease is to stop the bleeding and prevent the reoccurrence of bleeding. This can be accomplished with surgery or, in some cases, catheters and wire-mesh stents. It is crucial that hemorrhagic disease be treated quickly to prevent serious damage.

By contrast, the goal with carotid artery disease is to prevent an embolism. An embolism is a piece of plaque or blood clot that breaks away (ruptures) from the wall of the vessel and then travels with the blood flow until it becomes lodged in a smaller artery. In the case of CAD, there is a danger of an embolism blocking an artery inside the brain, which can cause a stroke. Physicians may choose to treat this disease with medication and lifestyle changes, or with more invasive techniques such as surgery and catheters.

Anitplatelet medications have been proven effective in preventing embolism in patients with CAD. These medications inhibit the blood clotting process and therefore reduce the risk of blood clot formation and subsequent stroke.

Aspirin is a strong and irreversible antiplatelet drug and is the first line of therapy for CAD. A more recent addition to drug therapy is clopidogrel, an antiplatelet even stronger than aspirin.

More and more research shows the value of cholesterol-controlling drugs in reducing the risk of cerebrovascular as well as cardiovascular disease. In 2005 a review of 14 trials involving 90,000 people showed that statins cut the risk of stroke and heart attack in people at high risk of vascular and heart disease, even if they did not have unhealthy levels of cholesterol. Also in 2005 researchers reported that a five-year trial involving 19,000 people found that newer antihypertensive drugs, especially when combined with cholesterol drugs, could prevent more than half of all strokes and heart attacks in people with high blood pressure.

In another advance in prevention of cerebrovascular disease, the U.S. Food and Drug Administration (FDA) in 2005 approved a simple blood test called the PLAC test to screen for risk of ischemic stroke. Previously cleared as a screening tool for heart disease, the test detects a blood protein that is more abundant in stroke patients. The PLAC test is available in physicians' offices.

Patients diagnosed with carotid artery disease may be advised by their physicians to make the following lifestyle changes:

In patients who do not respond to medical treatment, or who possess a significant degree of narrowing in the artery, procedures to treat carotid artery disease may include carotid endarterectomy and carotid artery stenting.

Carotid artery endarterectomy is an open surgical procedure where the carotid artery is exposed through an incision on the side of the neck. The artery is then clamped and the atherosclerotic material is removed. More than 95 percent of patients are discharged the day after the procedure.

Carotid artery stenting is a relatively new approach to the prevention of stroke in patients with carotid artery disease. A catheter is advanced into the carotid artery and a balloon is used to crush the plaque blocking the carotid artery (a procedure called angioplasty) and then a stent, or wire mesh tube, is implanted in the artery to keep it open. Some stents may be coated with drugs that prevent clotting and keep the arteries open. Stenting reduces the risk of a piece of plaque breaking off and traveling to the brain.

Many patients go home the day after the procedure, but some must go to the intensive care unit as a result of blood pressure and heart rate instability that can be caused by stenting. Currently, carotid artery stenting has a stroke rate equal to or greater than carotid endarterectomy. Its benefit is, as of now, in patients who are at higher risk for the “open” procedure as the result of heart disease or prior neck operations. One randomized trial, SAPPHIRE, evaluated surgery versus stent in patients with severe heart or lung disease or certain types of complex neck blockages. Patients who had surgery had twice the risk of death, MI or stroke.

Most physicians agree that stenting is emerging as the best option for patients who require carotid artery therapy and are at very high risk (e.g., prior heart attack, or existing health problem where the patient may not be able to tolerate anesthesia or open surgery). However, balloon angioplasty and stenting for carotid artery disease are currently in the investigation phase for low risk patients. Clinical trials are determining the safety and effectiveness of these techniques, as compared to carotid endarterectomy.

In addition, numerous studies are comparing the effectiveness of angioplasty to drug therapy for patients with stable heart disease. It has been believed that patients with chronic stable heart disease need to be treated with angioplasty or heart bypass surgery. However, a large study known as the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) suggested different results.

The trial found that drug treatment combined with lifestyle changes appeared to be as effective as angioplasty and drug therapy. There were no significant differences in death, nonfatal heart attacks or strokes between patients treated with medication alone and those who received drugs and angioplasty and stenting. These findings only pertained to individuals with stable heart disease and not acute heart attack patients. Researchers continue to examine the most effective prevention and treatment methods for individuals with cerebrovascular disease.