Carotid Artery Disease

What Is  Carotid Artery Disease? 

Like the arteries that  supply blood to the heart (the coronary arteries),  the carotid arteries can also develop atherosclerosis,  the build-up of fat  and cholesterol deposits, called plaque, on  the inside of the vessels. Over time,  the plaque narrows the artery, decreases blood flow to the  brain and can lead  to a stroke.  A stroke can occur if: 

• The  artery becomes extremely  narrowed
• A piece of  plaque breaks off and travels to  the smaller arteries of the brain 
• A blood clot forms  and blocks a narrowed artery

A stroke is similar to a heart attack. It occurs when brain cells (neurons) are deprived of the oxygen and glucose (a sugar) carried to them by blood. Oxygen and glucose are essential  for neurons to function and survive. If  the lack  of blood flow lasts for  more than 3 to 6 hours,  the damage is usually permanent. 

What Are  the Risk Factors For Carotid Artery Disease? 

The  risk factors for carotid artery disease are similar to those for coronary artery disease:

• Family history of atherosclerosis (either coronary artery disease or carotid artery disease) 
• Age (greater  in men than women less than age 75, but higher in women after age 75) 
• Smoking  
• Hypertension (high  blood pressure)
• Diabetes
• High levels  of low density lipoprotein (LDL, bad cholesterol) - although this link is not as strong as it is for  coronary artery disease

If you have coronary artery disease, you are more likely to get carotid artery disease. 

What Are the Symptoms of Carotid Artery Disease? 

There may not be any  symptoms of carotid artery disease. However,  there are warning signs of an impending stroke. A transient ischemic attack (also called TIA or "mini-stroke") is one of  the most important  warning signs of a stroke. A TIA  is a temporary episode of: 

• Blurred or loss of vision in one or both eyes 
• Weakness and/or numbness of your arm, leg or face on one side of your body 
• Slurring  of speech, difficulty talking or understanding what others  are saying 
• Loss  of coordination, dizziness  or confusion 
• Trouble swallowing 

A TIA may  last a few minutes or a few  hours. A TIA is  a medical emergency since it is impossible to predict  if it will progress into a major stroke. If  you or someone you know experiences these symptoms, get emergency help. Immediate treatment can save your life  or increase your chance  of full recovery. 

How Is Carotid Artery Disease Diagnosed? 

Carotid  artery disease may not have symptoms. It is important for those at risk to have regular physical exams by their doctor. A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (BROO-ee) may indicate you have disease. Bruits are not always present when blockages are present and may  be heard at times even with minor blockages. It is important to let your doctor know if you have had any symptoms, such as those listed above. 

Diagnostic tests include: 

• Carotid duplex ultrasound. An imaging procedure that uses high-frequency sound waves to view the blood vessels in the neck and to determine the presence  of narrowing in the carotid arteries. This study is recommended in anyone with heart disease and anyone over the age of 60. 
• Carotid angiography (carotid angiogram, carotid arteriogram, carotid angio). If carotid artery disease is suspected, prior to treatment,  your doctor may schedule an arteriogram. This is an invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm  or leg, and guiding it to the carotid arteries with the aid  of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of  your carotid arteries are taken. 
• Computerized tomography (CT Scan). A CT  of the brain may be performed if there is a possibility a stroke has already occurred. This test will reveal areas  of damage on the brain. 

How Is Carotid Artery Disease Treated? 

Carotid artery disease is treated by: 

• Lifestyle modification 
• Medications  
• Procedures

Lifestyle Modification 

To prevent further progression of disease, lifestyle modification  is recommended to limit all risk factors for coronary and  carotid artery disease. These modifications include: 

• Quit smoking and using tobacco products 
• Control high blood pressure and diabetes 
• Have regular check-ups with your doctor 
• Have your doctor check your lipid profile and get treatment,  if necessary to reach  a lipid goal of LDL less than 100 and HDL greater than 45 
• Eat foods low in saturated fats and cholesterol 
• Achieve and maintain a desirable weight 
• Exercise regularly 
• Control other stroke risk factors: limit the amount of alcohol you drink and  if you have atrial fibrillation, you should be on blood-thinning medications 

Medications 

All people with carotid disease should be on aspirin to decrease the risk  of stroke due to blood clots. In some cases, Coumadin (warfarin) may be prescribed. If so, blood work will need to be checked regularly to ensure you are on the proper dose. 

Procedures 

If the carotid artery has severe narrowing  or blockage,  a procedure must be done to open the artery and allow blood flow to the brain, to prevent future stroke: 

• Carotid stenting. This interventional procedure is currently under investigation. Performed in a catheterization laboratory, a small puncture is made in the groin. A specially designed catheter, with an umbrella tip is placed  over a guide wire and directed to  the area of narrowing in the  carotid artery. Once  in place, a small balloon tip is inflated  for a few seconds to dilate the artery. Then,  a stent (a small stainless steel mesh tube that acts as a scaffold to provide support inside your artery) is placed in  the artery and opens to fit the size  of the artery. Tiny filters are used to capture any particles that are released and prevent them from going to the brain and causing a stroke. The stent stays in place permanently. After several weeks, your artery heals around the stent Research is underway to study the effectiveness and safety of carotid stenting. It is hoped  this procedure will offer a non-surgical option to treat  carotid artery disease. 
• Carotid endarterectomy. This  is the standard surgical treatment for carotid artery disease. While the patient is under general anesthesia, an incision is made in the neck, at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow blood flow to the brain. 

Notes: DrJMinor

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EditText of this page (last edited January 6, 2010)