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Carotid Artery Disease

What is carotid artery disease?

Carotid Artery DiseaseCarotid artery disease occurs when the major arteries in your neck become narrowed or blocked. Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or “hardening of the arteries”. When enough plaque builds up to reduce or disturb blood flow through your carotid arteries, physicians call this problem carotid artery disease. Carotid artery disease is a serious health problem because it can cause a stroke.

Some plaque deposits are soft and are prone to cracking or forming roughened, irregular areas inside the artery. A piece of the plaque itself, or a clot, can break off and travel to a smaller artery in your brain and cause a stroke.

Quitting smoking is the most important change you can make to avoid this disease. Other ways to prevent carotid artery disease include:

  • Exercising regularly
  • Eating a healthy diet
  • Maintaining a healthy weight

Controlling factors that increase your chances of developing carotid artery disease, such as diabetes, high blood pressure, or high cholesterol, also help prevent the disease.

What are the symptoms?

Carotid artery disease may not cause symptoms in its early stages.

Unfortunately, the first sign of carotid artery disease could be a stroke. However, you may experience warning symptoms of a stroke called transient ischemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and include:

  • Feeling weakness, numbness, or a tingling sensation on one side of your body, for example, in an arm or a leg
  • Being unable to control the movement of an arm or a leg
  • Losing vision in one eye (many people describe this sensation as a window shade coming down)
  • Being unable to speak clearly

These symptoms usually go away completely within 24 hours. However, you should not ignore them. Having a TIA means that you are at serious risk of a stroke in the near future. You should report TIA symptoms to your physician immediately.

What causes carotid artery disease?

Hardening of the arteries (atherosclerosis) causes most cases of carotid artery disease.

Plaque may build up in the arteries because of an injury to the artery’s inner lining. Factors that injure artery walls include smoking, high cholesterol, and high blood pressure. Other factors that may increase your chances of developing carotid artery disease include diabetes and having a family history of hardening of the arteries.

What tests will I need?

After the history and exam we will perform a carotid ultrasound (if one has not already been performed). Sometimes, we will repeat the test to confirm the results prior to recommending treatment. In this painless test, one of our Vascular Technologists will hold a small ultrasound probe to your neck. This will show us the blood flow and any problems with the structure of blood vessels..

Carotid duplex ultrasound detects most cases of carotid artery disease. Therefore, your physician usually may not need to perform other tests. However, if ultrasound does not provide enough information, your physician may order one or more of the following:

  • CT and CTA scans take x-ray pictures in the form of slices of the brain and the arteries in your neck. CT scans can show an area of the brain that has poor blood flow.
  • MRA uses radio waves and magnetic fields to create detailed images.
  • Angiography: In this test, we inject dye through a catheter that is threaded into your arteries and then takes x-ray pictures. The structure of your arteries appears on the x-ray images because x-rays themselves cannot pass through the dye. This test shows how blood flows through the arteries and whether they are narrowed.

How is carotid artery disease treated?

Unlike Cardiologists and Radiologists, Vascular Surgeons are trained to offer ALL available treatments for carotid artery disease

Medical therapy: Patients with asymptomatic carotid artery disease may be best treated with medication. We will discuss with you the benefits of medical therapy and may not recommend any procedure to “fix” the carotid arteries.

Surgery: You may require surgery if your carotid artery disease is severe or has progressed. Signs of severe disease include having TIA symptoms, having experienced a stroke in the past, or just having a severely narrowed carotid artery even without symptoms.

During surgery, we remove the plaque that is blocking your carotid artery. The procedure is called carotid endarterectomy and can be performed using a local or general anesthetic, depending upon the particular situation. Once the anesthesia has taken affect, we make an incision in your neck and then remove the plaque contained in the inner lining of your carotid artery. This procedure removes the plaque and leaves a smooth, wide-open artery. You will likely be able to leave the hospital as early as the day after the procedure, depending upon how you feel. This procedure is safe and long lasting when done by a qualified vascular surgeon in the proper circumstances.

Angioplasty and stenting:  Angioplasty and stenting is a minimally invasive procedure to treat carotid artery disease.  It is usually performed using a local anesthetic. We  insert a long, thin tube called a catheter through a small puncture site over a groin artery and guide it through your blood vessels to your carotid artery. We then insert another catheter that carries a tiny balloon that inflates and deflates, flattening the plaque against the walls of the artery. Next, we place a tiny metal-mesh tube called a stent in the artery to hold it open. Your hospital stay after angioplasty and stenting is approximately the same as with endarterectomy. Carotid angioplasty and stenting is currently controversial because conclusive, long-term results are not yet available. Nevertheless, for patients who have medical conditions that increase the risk of carotid endarterectomy, angioplasty and stenting may be a good alternative. It has been approved for symptomatic patients considered to be at high risk for the surgical endarterectomy procedure, or for patients who have agreed to participate in ongoing clinical studies designed to determine its effectiveness.

What can I do to stay healthy?

If you do not require surgery, make sure you and your immediate family members understand the warning signs of TIA. Follow your physician’s instructions for any prescribed medications, such as aspirin, to thin your blood, or statins, to control your blood lipid (fat) levels. It is also important that you return for any scheduled follow up tests because the carotid blockage may worsen over time, even without warning symptoms.

Changing some lifestyle factors may limit the progression of your carotid artery disease. The first step smokers should take is to quit smoking. Other changes that can decrease your risk of carotid artery disease include losing weight, exercising regularly, and eating a diet low in saturated fats.