Carotid Disease

What do your carotid arteries do?

The carotid arteries are the main arteries in your neck that supply blood to your brain. A substance called plaque accumulates inside your arteries as you age. If too much plaque builds up in your carotid artery, it can cause the artery to narrow (carotid stenosis). Small clots can form, then break off and travel to the brain, causing a minor or major stroke.

Up to 3% of individuals older than 65 have carotid artery disease. Your risk increases as you age, and is heightened if you have a history of smoking, high blood pressure, high cholesterol, diabetes or heart disease. Carotid stenosis is responsible for up to one-third of all strokes. Stroke causes 1 in every 15 deaths. About 700,000 strokes occur every year, usually in men.

What are the symptoms of carotid artery disease?

Most people with carotid artery disease, even with severe blockage, experience no symptoms. The condition is found in a routine physical or ophthalmological examination, or is found following a stroke. Very rarely, carotid artery disease may cause ringing in the ears or fainting due to decreased blood flow to the brain.

Neck pain is not a symptom of carotid artery disease. The first signs of carotid artery disease may be a stroke, mini-stroke or TIA symptoms, such as weakness or numbness on one side of your body. You may also experience slurred speech or facial drooping.

What causes carotid artery disease?

The most common cause is a build-up of plaque in the carotid arteries due to multiple risk factors, such as a history of smoking, high cholesterol, high blood pressure and diabetes. This is the same type of plaque that forms in the heart and causes heart attacks. In rare cases, carotid artery may narrow due to inflammation.

How is carotid artery disease diagnosed?

Routine physical exams include the physician using a stethoscope to listen to your heart and certain blood vessels.  A whistling sound or "bruit" coming from the carotid artery may indicate plaque is building up inside the artery and lead your doctor to recommend further testing or a consultation with a vascular surgeon. Ultrasound is the main diagnostic technique uses to evaluate carotid artery disease. Ultrasound is a cost effective, painless way to diagnose carotid narrowing. It is extremely accurate in identifying carotid artery narrowing as well as demonstrating disease free carotid artery anatomy.  Alternative radiological tests are sometimes used to determine the presence and degree of any narrowing.  These include a computerized tomography (CT) scan, magnetic resonance angiography (MRA) or angiogram.

Treatment strategies

  • Medication: Aspirin, and medications that lower your cholesterol and blood pressure are commonly prescribed when the degree of narrowing is less than 50-60%.  Medications may need to be adjusted as the disease progresses
  • Smoking cessation
  • Carotid interventions
    • Open surgery- Carotid endarterectomy- 60 years old, most common vascular operation, very safe, 1-2 hours, overnight hospital stay
    • Transfemoral stenting- for high risk surgical patients, very safe, 1-2 hours, overnight hospital stay
    • Hybrid stenting (TCAR) - small open incision, for high risk patients, 1-2 hour procedure, overnight stay
Content reprinted with permission from the Society for Vascular Surgery® (SVS).

 

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