The initial test after listening to the arteries with a stethoscope held over the neck is ultrasound examination of the arteries. More refined tests include contrast angiography and magnetic resonance angiography.

Once a diagnosis of carotid artery stenosis has been made the next steps include whether the blockage requires treatment and, if so, which procedure should be performed.

The time-honored therapy for carotid artery stenosis has been carotid endartectomy, an open operation through a neck incision where the blockage is removed and the artery repaired. The new procedure on the block is carotid artery stenting where the artery is dilated with a balloon placed over a catheter, and a stent is left in place to keep the artery open.

There are hazards involved in both of these procedures; the most serious being a major stroke. The stent approach is reserved for high-risk patients and for those who have had previous carotid surgery, irradiation of the neck or complicating medical diagnoses which would make open surgery hazardous. Obviously, most patients would prefer an operation which does not leave a neck scar, but this might not be the best option for many patients.

The best individual to help you decide which procedure should be done is a highly skilled vascular surgeon who is well-trained to perform both carotid endartectomy and carotid stenting. The University Vascular Surgeons at UT Medical Center have East Tennessee’s only approved program to train fellows in endovascular surgery. They performed the first carotid artery stent in Knoxville eight years ago.