Carotid Artery Disease

Carotid artery disease is the narrowing of the carotid arteries, the main arteries located on the sides of your neck. These arteries supply blood flow directly to the brain.

A blockage consisting of an atherosclerotic plaque can develop in the artery. This blockage can narrow the channel for blood to flow through and also cause turbulence and small clots to form on the plaque surface.

These small clots and bits of plaque can “break off” into the bloodstream and be carried away – up to the brain and cause a stroke or mini-stroke. A stroke is a sudden change in neurological functioning that results in paralysis, weakness, blindness, numbness or difficulty with speech.

Do I Have Carotid Artery Disease

Symptoms of carotid artery disease consist of stroke or mini-stroke symptoms. Due to the sudden blockage of blood flow to an artery in the brain, the nerve cells in the brain stop working properly.

Symptoms can include:

  • Paralysis of an arm or leg (usually on one side of the body)
  • Weakness of an arm or leg
  • Numbness
  • Blindness in one eye
  • One-sided facial droop
  • Slurring of speech or difficulty speaking

A mini-stroke, or transient ischemic attack (TIA), consists of the same symptoms above but, unlike a stroke, usually passes within a few minutes. Both a stroke and mini-stroke are medical emergencies and should be dealt with by calling 911 or your local EMS for immediate transport to a hospital.

Most of the time patients may not have any symptoms of carotid artery disease at all. However, during a physical exam, we may hear a “bruit,” an abnormal whooshing sound, through the stethoscope when listening to your neck.

Other conditions such as dizziness, fainting spells, or vertigo are not usually directly associated with carotid artery disease but may lead to tests that discover its presence.

Common Risk Factors

  • Age
  • Smoking
  • Coronary artery disease (history of heart attacks)
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Kidney failure
  • History of radiation to the neck (i.e. treatment of neck cancer)

Diagnosis

Ultrasound

This is usually the first line test to evaluate for carotid artery disease. It is a painless, non-invasive test that can be done in your surgeon’s office in less than 30 minutes. It involves placing an ultrasound probe on your neck and obtaining images of your arteries and measuring the blood flow.

CT Angiography / MR Angiography

You may sometimes need a CT scan or MRI that focuses on evaluating the arteries of your neck to better image the blockages and surrounding normal tissues. This test can also confirm the findings of an ultrasound if we anticipate surgery.

These tests have the added advantage of possibly identifying another cause for symptoms that might not clearly be from carotid artery disease. These tests involve injecting a contrast agent into your veins.

Angiography

Angiography may be used to image the carotid arteries, usually after the above less-invasive tests have been performed, in order to obtain finer detail about the carotid arteries. This may be because of disagreement between other tests or as part of a planned treatment such as stenting (see Treatment options).

This involves injecting contrast agents (“dye”) through a catheter into an artery. Typically we give the patient a mild sedative before and during the procedure, and the area over the artery, usually in the groin or elbow, receives a local anesthetic. Injecting the dye into the artery or vein creates an image called an “angiogram” that provides the detail necessary to plan out the proper treatment for you.

Treatment options

Treatment of carotid artery disease depends on several factors. These factors include whether or not the blockage is causing stroke or mini-stroke symptoms, how severe the blockage is, and a patient’s overall medical condition.

Regardless of these considerations there are medications and other steps that we use to treat carotid artery disease whether or not we plan on surgery. These include anti-clotting medications (such as aspirin), anti-hypertensive medications, cholesterol lowering medications, and steps to stop smoking.

If you have symptoms of a stroke or mini-stroke and have a blockage over 60%, you should consider surgery. Some patients with blockages less than 60% but who have very complex or “vulnerable to rupture” plaques in the carotid arteries may need surgery as well. Patients who have no symptoms but have blockages over 70% are typically considered for surgery.

The rationale behind recommending surgery is to prevent stroke. Patients who have had a stroke or mini-stroke are at high risk for a second event. The risk for patients with no symptoms is primarily based on the observation that their risk for stroke increases as the blockage worsens. When this risk of stroke outweighs the risks of surgery the we recommend surgery.

Many patients have blockages that do not meet criteria for repairs. It is imperative that we treat these patients to control the risk factors that lead to carotid artery disease. They also need to have regular, scheduled follow-up ultrasounds to track the effect of their blockage.

A significant group of patients will experience worsening of the blockage and eventually require surgery. Surgical treatment consists of two primary options: endarterectomy and stenting.

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