What is Carotid Artery Disease?
A special form of PAD involves the carotid arteries passing from the top of the chest up the right and left side of the neck, carrying blood to the brain. Atherosclerosis can involve the middle of the carotid artery, and in certain circumstances can result in small or large strokes or loss of vision in one eye or the other. In such a circumstance, often identified by ultrasound examination (or other imaging techniques), surgical removal of the plaque (another form of endarterectomy) can significantly reduce the likelihood of further stroke-related problems.
The carotid arteries are the main arteries in your neck that supply oxygen-rich blood to your brain.When 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, and can lodge itself in the smaller arteries in the brain which will reduce the blood flow to that particular area it supplies and can lead to a Stroke or a Cerebrovascular accident (CVA).
Difference between a TIA (Minor Stroke) and a CVA (Stroke)
Transient ischemic attack (TIA) or a minor stroke usually happens when there is a temporary interruption of blood flow to the brain due to a traveling blood clot or a plaque. The symptoms are the same as a stroke but usually will last for less than 24 hours and the person may feel back to normal again. This increases your risk for a recurrent stroke.
In a stroke (CVA), irreversible damage to brain tissue is caused by lack of blood flow for a prolonged period. The restricted blood flow is caused by either a traveling blood clot or plaque that lodges in a small artery within the brain, or by a ruptured artery or aneurysm that causes bleeding around the brain and diverts needed blood away from brain tissue.
Other possible causes that are not very common are fibromuscular dysplasia (inflammation of the lining of the vessel wall) which can cause narrowing in the arteries without any atherosclerosis, carotid dissections which are caused by tears in the lining of the carotid artery. 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 (Society for Vascular Surgery).
Risk Factors:
- Smoking
- High cholesterol
- High blood pressure
- Diabetes
Symptoms:
- May be absent in most people. It is usually found by a physical exam, an ultrasound study, or a CT scan prior to or after a stroke
- Ringing in ears or fainting due to decreased blood flow to the brain (rare)
- Sometimes the first signs of carotid artery disease are stroke symptoms:
- Weakness of extremities, sudden trouble walking, dizziness, loss of balance or coordination (especially one side of the body)
- Numbness – face/around the lips, facial droop
- Slurred speech (trouble speaking or understanding speech)
- Sudden change or loss of vision in one or both eyes
- Sudden confusion
- Sudden severe headache with no known cause
Diagnosis:
Routine physical exam – when listened during an exam with a stethoscope over the carotid artery the physician may hear a whistling sound or a bruit coming from the carotid artery which can indicate the build of plaque in your arteries. The most commonly used and noninvasive diagnostic test is the Carotid artery duplex ultrasound which can provide information about the narrowing in the artery and its severity. Other tests that can be used are a computerized tomography (CT) scan or magnetic resonance angiography (MRA).
Treatment
Medications:
like aspirin, medications to lower blood cholesterol, blood pressure
Smoking Cessation
Surgery:
Carotid Endarterectomy (surgical removal of plaque) or carotid artery angioplasty and stenting. This is usually recommended only if the degree of narrowing in the carotid artery is greater than 60 % if you had a recent stroke or any new symptoms or above 80 % if you are asymptomatic.
Surgery is not recommended for mild to moderate stenosis as there is a low risk for stroke and the surgery itself can cause a stroke and does not completely remove the risk of you having a stroke post the surgery.
Carotid Endarterectomy:
It is an open surgery. It is done by making a small incision or cut on your neck directly above the carotid artery. The artery is then opened, and the plaque is removed.
Carotid Artery Stenting:
In this technique, a catheter is inserted through the groin and a stent is placed at the area where the plaque is identified. The stent remains in the artery and helps it to stay open.
*Your Vascular surgeon will discuss possible surgical or medical management and surveillance as appropriate