Expert Treatment for Carotid Artery Disease

At Western Surgical Group, we are the only practice in Northern Nevada offering all three surgical options for treating carotid artery disease. This comprehensive approach allows our vascular surgeons to choose the best treatment for each patient’s unique needs — whether that’s traditional open surgery, revolutionary minimally invasive techniques, or advanced stenting procedures.

Conditions We Treat:

  • Carotid Artery Disease
  • Carotid Artery Stenosis (narrowing)
  • Stroke prevention in high-risk patients

What Is Carotid Artery Disease?

Carotid artery disease occurs when plaque (fatty deposits) builds up inside the carotid arteries — the major blood vessels supplying oxygen-rich blood to the brain. When plaque accumulates, it can significantly narrow or block the artery, increasing the risk of stroke. Carotid artery disease is one of the leading causes of stroke in the United States.

Common symptoms may include:

  • Transient ischemic attacks (TIAs or “mini-strokes”)
  • Sudden numbness or weakness in the face, arm, or leg
  • Difficulty speaking or understanding speech
  • Vision problems in one or both eyes
  • Dizziness or loss of balance

Many patients have no symptoms until a stroke occurs, which is why screening is important for those at risk.

Our Three Carotid Treatment Options

1. Carotid Endarterectomy (CEA)

The Gold Standard Open Surgical Approach

Carotid endarterectomy has been the gold standard treatment for carotid artery disease for decades, with proven long-term results in preventing stroke.

How It Works:

During carotid endarterectomy, the surgeon makes an incision in the neck to expose the affected carotid artery. The artery is opened, and the surgeon carefully removes the plaque buildup from the inner lining of the vessel. Once plaque is cleared, the artery is closed — often with a patch to widen the artery and prevent re-narrowing.

What to Expect:

  • Performed under general or regional anesthesia
  • Usually takes one to two hours
  • Overnight hospital stay for monitoring
  • Return to normal activities within a few weeks

Best For:

  • Patients with significant carotid stenosis
  • Those who have had symptoms (TIA or mild stroke)
  • Patients with favorable anatomy for open surgery

2. Transcarotid Artery Revascularization (TCAR)

Revolutionary Minimally Invasive Treatment

TCAR revolutionized carotid stenting, cutting stroke rates in half relative to standard carotid stenting — on par with standard carotid endarterectomy. Dr. Levin was the first surgeon to perform TCAR in Northern Nevada and started TCAR programs at several area hospitals.

How It Works:

TCAR is performed through a small incision at the base of the neck, just above the collarbone. Unlike traditional carotid stenting, TCAR uses a unique system that temporarily reverses blood flow away from the brain during the procedure, preventing any loose plaque from traveling to the brain and causing a stroke. A stent is then placed to open the narrowed artery.

Advantages of TCAR:

  • Significantly lower stroke risk than traditional carotid stenting
  • Minimally invasive approach
  • Faster recovery than open surgery
  • Shorter hospital stay (often same-day or overnight)
  • Smaller incision and less neck discomfort

Best For:

  • Patients who prefer minimally invasive treatment
  • Those at higher risk for open surgery
  • Patients with challenging anatomy for traditional endarterectomy

3. Carotid Artery Stenting

Minimally Invasive Alternative for Select Patients

Carotid artery stenting is performed through a small puncture in the groin or arm. A catheter is guided through the blood vessels to the carotid artery, where a stent (small mesh tube) is placed to hold the artery open and improve blood flow.

How It Works:

Using advanced imaging, the surgeon navigates a thin catheter to the narrowed carotid artery. The narrowed area is opened with a balloon, and a stent is placed to keep the artery open. The procedure is performed under local anesthesia with sedation.

Best For:

  • Patients with specific anatomical considerations
  • Those who have had previous neck surgery or radiation
  • Select cases where open surgery carries higher risk

Why Choose Western Surgical Group for Carotid Treatment?

  • Only practice in Northern Nevada offering all three treatment options
  • Pioneers in TCAR — Dr. Levin performed the first TCAR in Northern Nevada
  • Ability to choose the best approach for each patient
  • Board-certified vascular surgeons with extensive experience
  • Advanced imaging and monitoring throughout procedures
  • Comprehensive pre-operative evaluation and post-operative care

Benefits of Carotid Artery Procedures

  • Significant reduction in stroke risk
  • Improved blood flow to the brain
  • Relief of symptoms related to carotid stenosis (if present)
  • Prevention of future TIAs or strokes
  • Options for both minimally invasive and traditional approaches

Recovery and Aftercare

After Carotid Endarterectomy:

Patients may experience mild throat or neck discomfort, which typically resolves quickly. Most patients are discharged the next day and can return to normal activities within 2-4 weeks.

After TCAR or Carotid Stenting:

Recovery is typically faster with minimally invasive approaches. Many patients go home the same day or after an overnight stay. Normal activities can usually resume within 1-2 weeks.

Long-term Care:

  • Follow-up imaging to monitor the treated artery
  • Management of risk factors (blood pressure, cholesterol, diabetes)
  • Antiplatelet medications to prevent clots
  • Lifestyle modifications (smoking cessation, healthy diet, exercise)

Risks and Considerations

As with any procedure, carotid artery treatments carry some risks. These can include:

  • Stroke (rare, especially with TCAR)
  • Bleeding or hematoma
  • Infection
  • Nerve injury (temporary or permanent)
  • Heart attack
  • Re-stenosis (re-narrowing of the artery)

Your surgical team will discuss risks specific to your health status and explain how they plan to minimize complications. Careful patient selection and preoperative evaluation help maximize benefits and safety.

Divisions Involved in Your Care

Diagnoses We Treat

Frequently Asked Questions

Your vascular surgeon will evaluate several factors including the degree of narrowing, your symptoms, overall health, anatomy, and personal preferences. Being the only practice in Northern Nevada offering all three options means we can truly individualize your treatment plan rather than being limited to one approach.

All three procedures have excellent success rates when performed by experienced vascular surgeons. Carotid endarterectomy has decades of proven results. TCAR has demonstrated stroke rates equal to endarterectomy but with the benefits of a minimally invasive approach. Your surgeon will discuss expected outcomes based on your specific situation.

With proper medical management and lifestyle modifications, carotid procedures provide durable results. Regular follow-up with ultrasound monitoring helps ensure the artery remains open. Some patients may develop new blockages over time, which is why ongoing vascular care is important.

Most patients will need antiplatelet medications (such as aspirin and/or clopidogrel) after carotid procedures to prevent blood clots. The specific medications and duration will depend on the procedure performed and your individual risk factors.

While procedures are highly effective, new plaque can develop over time, especially if risk factors aren't controlled. This is called restenosis. Regular follow-up care, imaging, and management of risk factors (cholesterol, blood pressure, diabetes, smoking) are essential to long-term success.

TCAR's unique flow reversal system temporarily directs blood flow away from the brain during the procedure, preventing any debris from reaching the brain. This innovation has cut stroke rates in half compared to traditional carotid stenting, making it as safe as open surgery while maintaining the benefits of a minimally invasive approach.

Timing depends on several factors including the severity of your stroke or TIA, your overall medical condition, and the degree of carotid narrowing. In some cases, urgent or semi-urgent treatment may be recommended. Your vascular surgeon will determine the optimal timing based on your specific situation.

Untreated significant carotid stenosis carries a substantial stroke risk, particularly in patients who have already had symptoms. Your doctor may recommend aggressive medical management with medications, lifestyle changes, and close monitoring. However, surgery or stenting is often the most effective way to reduce stroke risk when narrowing is severe.