From an interview with
Dr. Leia Edenfield
McLeod Vascular Associates  Seacoast

Here is a summary of Dr. Edenfield’s comments:
The Carotid Artery is one of the blood vessels that takes blood to the brain.  It branches off the aorta, which comes from your heart right through your chest to the brain.  There are two carotid arteries, one on each side of the neck. Most  of the blood that’s getting to your brain goes through those carotid arteries.  As patients age, have high blood pressure, high cholesterol or smoke, they can develop blockages in these carotid arteries.
 
Several different treatments exist for a blocked carotid artery. Depending on how severe the blockage is, your surgeon may recommend medical management. It usually involves taking a baby aspirin every day, a medication for your cholesterol (a statin) and quitting smoking.
 
If you’ve had symptoms of a stroke, mini-stroke (Transient Ischemic Attack) or if your blockage is greater than 70%, we usually recommend one of 3 types of surgery to prevent a stroke.
 
One rather old-fashioned way of fixing a carotid artery is the  carotid endarterectomy. While the patient is asleep, an incision of several inches is made on the side of the neck where the blockage exists. We open the artery to clean out the blockage. Then, the artery is closed with a patch to prevent it from narrowing as it heals.

Inserting a stent inside the artery represents another way to clear the blockage. The surgeon goes through an artery in the groin, threading a small tube (catheter) it up to the blockage and, with no large incisions, placing the stent. In certain patients, this becomes the best way to treat the blockage. Although it carries a higher risk of stroke.
 
These days, one of the more popular ways of treating carotid artery blockages, these days Transcarotid Artery Revascularization (TCAR). A hybrid between the stent surgery and the open surgery, TCAR involves a small incision at the base of the neck, just above the clavicle, where we go down to where the carotid artery is. Then we insert the stent using a sheath, which is a hollow tube that’s inserted into the artery.
                                                                                      
A so-called “flow reversal system” makes TCAR special. The system reverses blood flow away from the brain during the stent placement. This prevents any small debris or plaque from breaking off, going to the brain while we’re operating and causing a stroke. TCAR requires a smaller incision, directly place the stent and  carries a much lower risk of stroke.

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