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Carotid
Artery Disease is caused by plaque build-up (atherosclerosis)
within the lining of the arteries. This process (also
known as hardening of the arteries) worsens over time
as plaque continues to collect. The carotid arteries
(one on each side of the neck) supply blood to the large
frontal part of the brain, which controls thinking,
speech, personality, sensory and motor function. Carotid
artery disease can result in a transient ischemic attack
or stroke.
Carotid
artery disease may not present any symptoms. However,
there may be warning signs of a stroke. Transient ischemic
attack (TIA) is one of the most important warning signs
of a stroke. A TIA may occur as the atherosclerotic
plaque build-up can cause complete artery blockage or
break off into a small floating particle that can result
in a blockage. TIA's are temporary and may last a few
minutes or a few hours. Their symptoms may occur alone
or in combination. TIA's are strong predictors of future
strokes; a person who has experienced a TIA is 10 times
more likely to suffer a major stroke.
TIA
Symptoms
- Sudden
loss of vision or blurred vision in one or both eyes
- Weakness
and/or numbness on one side of the face, or in one
arm or leg
- Slurred
speech, difficulty talking or understanding what others
are saying
- Loss
of coordination
- Dizziness
or confusion
- Difficulty
swallowing
Diagnosing
Carotid Disease
Your doctor will listen to the arteries in your neck
with a stethoscope to see if he is able to detect a
bruit (an abnormal rushing sound), which may indicate
carotid artery disease. Bruits are not always present
when there are blockages. Other out-patient diagnostic
tests include:
- Carotid
Duplex Ultrasound - a non-invasive test performed
in the office
- Carotid
Angiography - a minimally invasive procedure performed
in an out-patient hospital setting.
- MRA
- magnetic resonance angiogram
- CT
scan
- CTA
- computed tomography angiogram
 Recommendations
for the prevention of Carotid Artery Disease progression
- Quit
smoking and stop tobacco product use
- Control
high blood pressure, cholesterol, diabetes and heart
disease
- Have
regular checkups with your doctor, including LDL and
HDL levels
- Eat
foods low in saturated fats, cholesterol and sodium
- Achieve
and maintain a desirable weight
- Exercise
regularly - 30 minutes 3 to 4 times per week
- Limit
alcohol intake
Treatment
of Carotid Artery Disease
Carotid artery disease is treated according to the severity
of the disease:
- Lifestyle
modifications as mentioned above
- Prescribed
medications such as blood thinners
- Surgical
Treatment
Surgical
Treatment Procedures
A surgical procedure must be performed if there is severe
narrowing or blockage in the carotid artery, to prevent
a future stroke. There are two options; Carotid Endarterectomy
or Carotid Stenting and Angioplasty.
 Carotid
Endarterectomy is the traditional open surgical
repair which has been proven to be beneficial for symptomatic
patients with a 50 percent or greater stenosis (blockage)
and for asymptomatic patients with a 60 percent or greater
stenosis (blockage). During this procedure, an incision
is made in the neck at the site of the carotid artery
blockage. The surgeon removes the plaque from the artery
and stitches the vessel closed. Blood flow to the brain
is restored through its normal path.
Carotid
Stenting and Angioplasty has been FDA approved optionfor
some patients with carotid artery disease. All patients
are not candidates for this procedure. During this procedure,
a balloon catheter is inserted through a sheath in a
blood vessel. With X-ray guidance, the catheter is placed
through the blood vessel and directed to the carotid
artery at the site of the blockage or narrowing. Then
a specially designed guidewire with a filter is placed
beyond the area of blockage or narrowing. Once in place,
the balloon tip is inflated for a few seconds to open
or widen the artery. The filter collects any debris
that may break off of the blockage. A stent (small mesh
tube) is placed in the artery and opens to fit the size
of the artery. The stent stays in place permanently
and acts as a scaffold to support the artery walls and
keep the artery open. After several weeks, the artery
heals around the stent.
Patients
often return to regular activities within 1 to 2 weeks
after these procedures.
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