Carotid Artery Disease
What is Carotid Artery Disease?
Carotid artery disease occurs when one or both of the carotid arteries are narrowed or blocked with a waxy substance called plaque. When the body is functioning optimally, the carotid arteries carry oxygenated blood to the head and brain. There are two carotid arteries — one on either side of the neck — and those arteries are made up of both internal and external arteries. The internal arteries take oxygenated blood to the brain, while the external arteries move oxygen-rich blood to the neck, face and scalp.
However, aging and a number of other factors can cause plaque to build up in those arteries, cutting off that essential blood flow. Plaque is made up of cholesterol, fat, calcium and other substances that can accumulate and cause the arteries to narrow, a condition known as carotid stenosis.
Blocked carotid arteries can have serious complications. In fact, carotid artery disease is a significant cause of stroke among Americans. Stroke can also occur if a blood clot forms within the carotid arteries, which can happen if plaque buildup cracks or ruptures.
What Causes Carotid Artery Disease?
In many cases, someone who has carotid artery disease may have no noticeable symptoms. However, as the blockage worsens, symptoms may result. Symptoms related to carotid artery disease include:
Bruit, which is a whooshing sound from the carotid arteries heard through a stethoscope.
Stroke, which is a severe medical condition that requires immediate medical attention to limit its effects on the brain.
Transient ischemic attack, also called a ministroke, which can cause many stroke-like symptoms, such as dizziness, difficulty seeing or weakness on one side of the body
If symptoms of carotid artery disease are exhibited or if a ministroke or stroke has been experienced, a doctor will confirm a diagnosis by reviewing symptoms, considering personal and family medical history, and conducting a physical exam. To make a definitive diagnosis, testing will be ordered, including:
- Carotid ultrasound
- Carotid angiography
- Magnetic resonance angiography
- CT angiography
Treatment for carotid artery disease will vary depending on a person’s individual needs and medical history. In cases that are incidentally found and patient that are not symptomatic, a doctor may recommend making lifestyle changes. These changes may include addressing the main risk factors; High blood pressure, diabetes, high cholesterol and smoking. Eating a heart-healthy diet with fruits and vegetables, getting to and maintaining a healthy weight, finding healthy ways to manage stress, getting regular physical activity and quitting smoking. In other cases, a doctor may prescribe medications to prevent blood clots or manage other contributing medical conditions, such as diabetes and high cholesterol.
In cases where patients exhibit symptoms such as a mini stroke or have a history of strokes, along with the confirmation of artery blockage through noninvasive imaging techniques like CT angiography, MR angiography, or ultrasound, a more definitive acute treatment might be recommended. This treatment approach could involve an open procedure called carotid endarterectomy, which entails the removal of plaque from the affected artery. Alternatively, the patient might be considered for a minimally invasive approach involving the insertion of a stent at the site of the blockage.
The decision regarding which procedure to pursue hinges on several factors, including the patient's age, any concurrent health conditions like recent heart attacks or advanced pulmonary disease, the location of the plaque, and the feasibility of surgical access. Based on a comprehensive assessment of these factors, the surgeon will determine whether one procedure is more suitable than the other for the patient's specific case.
If the carotid artery has narrowed due to carotid stenosis, a medical procedure called carotid endarterectomy may be recommended. During the procedure, an incision is made into the carotid artery and the part of the arterial lining blocking blood flow is removed.
Another treatment option involves a procedure called carotid artery angioplasty, where arteries are widened to restore blood flow. During an angioplasty, a thin tube with a deflated balloon at its end is threaded through a blood vessel to the carotid artery. The balloon is then inflated to push the plaque back against the artery wall and a stent is put inside to support the artery wall. "