Carotid Artery Stenosis

 

Illustration showing carotid artery stenosisThe carotid arteries are the two large blood vessels that carry blood from your heart to your brain. Carotid artery disease, also known as carotid artery stenosis, is a form of atherosclerosis and happens when the inner walls of the carotid arteries start narrowing. The narrowing in the carotid arteries generally happens due to a blockage of build up from cholesterol, inflammatory and fatty deposits, also referred to as plaque. When the Carotid arteries narrow and build up plaque, it restricts blood flow that gets to the brain. If the brain does not get enough blood, it cannot get the oxygen and nutrients it needs to work properly and can lead to a stroke.

Carotid artery stenosis does not happen overnight, it develops slowly over time, and you may not even realize you have it.

Symptoms

Carotid artery disease often does not produce any signs or symptoms.

Some patients may experience a transient ischemic attack (TIA), which is also known as a mini stroke. The symptoms of a TIA can be blurred vision or brief loss of vision, slurred speech, dizziness and loss of coordination, numbness, or weakness on one side of the face, arm, or leg.

If you experience any of these symptoms, please call 9-1-1.

Diagnosis

Since carotid artery disease often has no symptoms, if you are at risk, it is important to have regular physical exams with your physician. In your physical exam, your physician can screen you by listening to your carotid artery with a stethoscope placed on your neck. If they hear an abnormal rushing sound, referred to as bruit, it may indicate carotid artery disease. Bruits are not always present in a blockage and would not be heard through a stethoscope in a physical exam.

Request a Physician Referral

Your physician may want to send you for a diagnostic test to diagnose that you have carotid artery disease. Possible diagnostic tests include:

  • Carotid ultrasound

    This noninvasive and painless screening test uses high-frequency sound waves to generate an image of the carotid arteries and can be helpful in identifying narrowing in the carotid arteries.

  • Magnetic resonance angiography (MRA)

    MRA is a type of magnetic resonance image (MRI) scan and is used to examine blood vessels throughout the body. It does this by using a magnetic field and radio waves to provide an image of the carotid arteries. This test can provide a physician with important information about the carotid and vertebral arteries and the degree of stenosis.

  • Computerized tomography angiography (CTA)

    During this CT scan, a dye is injected into the patients arm to highlight the blood vessels and obtain a high-resolution, 3D image of the carotid artery. These CTA images help physicians determine the degree of stenosis in the carotid and vertebral arteries.

  • Carotid angiography

    This invasive imaging procedure is a blood flow test. Dyes are injected into the patient’s blood vessels, while an X-ray is being taken to produce a picture of the patient’s blood flow. This procedure assists the physician in determining exactly where the narrowing is located and will help to guide further treatments.

Treatment Options

Carotid artery disease can be treated by a couple different options and is tailored to each patient plan.

  • Lifestyle changes

    Exercising regularly, maintaining a healthy weight, stop smoking, limiting cholesterol and fats, and eating a healthy diet are just a few of these permanent lifestyle changes recommended.

  • Medications to treat blockages

    Anti-platelet Medication

    • Medications that are prescribed to stop the cells in the blood, known as platelets, from sticking together and forming a clot. Most commonly used is Aspirin.

    Anticoagulant Medications

    • Medications that are prescribed to help thin your blood and delay the risk of blood clots. Most commonly used is Warfarin (Coumadin).
  • Blood pressure and cholesterol medications

    Medications to help control your blood pressure and help lower your Cholesterol.

If the narrowing or blockage in the carotid artery is severe enough, then a surgical procedure may be recommended to help assist in opening the artery, which would then increase the blood flow to the brain. These surgical procedures include:

  • Carotid angioplasty and stenting

    • These two procedures can be done when a patient does not qualify for carotid endarterectomy, due to health conditions that can make surgery too risky.
    • During this non-surgical procedure, a surgeon temporarily inserts a balloon catheter to help widen the area, by squeezing the plaque against the artery walls and allowing better blood flow.
    • For patients that meet the eligibility criteria, angioplasty is normally combined with another procedure, stenting. Stenting is when a metal coil, also known as a stent, is placed in the clogged artery to help prop the artery open and decrease the chance of the artery narrowing again.
  • Carotid endarterectomy (CEA)

    • Most commonly performed surgical treatment for patients with severe narrowing or blockages in their carotid artery.
    • During this surgical procedure, a surgeon makes a small incision in the neck and surgically removes the plaque from the artery and then repairs the diseased portion of that artery. This then allows blood flow to be restored through the previously blocked artery and reduce the risk of stroke.
  • TransCarotid artery revascularization (TCAR)

    • TCAR is less-invasive treatment alternative to a carotid endarterectomy. This treatment option is generally recommended for patients who are considered too high risk for surgery, due to age and medical conditions.
    • TCAR temporarily reverses the patient’s blood flow during the procedure to help protect the brain. By doing this, any small bits of plaque that may normally break off during the procedure are then redirected away from the brain, preventing a stroke from happening.