CAROTID ARTERY DISEASE

Carotid artery disease is a progressive disease. The carotid arteries, which are located in the neck, supply blood to the brain. Certain health problems damage the inside of the carotid arteries. Over time, this damage increases the chances of having a stroke. If you have carotid artery disease, treatment is available that may lower your risks for problems.

About Carotid Arteries

In a healthy carotid artery, the inside is open and the lining of the artery wall is smooth. This lets blood flow freely from the heart to the brain providing all the oxygen-rich blood and nutrients it needs to function well. Some health factors damage artery walls making them narrow and rough. A damaged artery no longer has a smooth lining. This allows cholesterol and other particles in the blood to stick to the artery walls and form plaque or fatty deposits.

This is atherosclerosis (ATH-er-o-skler-O-sis), sometimes called “hardening of the arteries”. As the plaque builds up, it can narrow the artery. Blood may also collect on the plaque and form blood clots. Plaque can rupture, causing pieces to break off and enter the bloodstream. At the same time, the rupture can produce more blood clots. Fragments of plaque and tiny blood clots (emboli) then travel to and block smaller arteries in the brain. This cuts off blood flow to a portion of the brain, resulting in a stroke.

About Strokes

A stroke is loss of brain function due to death of brain tissue. When blood flow is cut off, brain tissue can die causing the loss of brain function. A stroke can cause severe disability, including paralysis, difficulty speaking and trouble doing the simplest tasks. And, some strokes are deadly. One warning sign of a stroke is a TIA (transient ischemic attack). A TIA is also known as a “mini-stroke”. It has the same symptoms as a stroke, but the symptoms go away within minutes or hours, and there is no permanent brain damage.

Risk Factors

Plaque in the carotid arteries increases your risk of stroke. Other risk factors include:

  • having a prior TIA, stroke or heart attack
  • high blood pressure
  • high cholesterol levels
  • smoking
  • diabetes
  • age (greater frequency in men than women less than age 75, but higher in women after age 75)
  • family history of atherosclerosis (either coronary artery disease or carotid artery disease)

Symptoms of Carotid Artery Disease

You might not know you have carotid artery disease because there are usually no signs in the early stages. Symptoms may not occur until the disease is severe enough to keep blood from flowing to your brain. If symptoms occur, they are the same as stroke and TIA symptoms. The longer you delay getting treatment, the more damage a stroke can do. Call 911 right away if you have any of these symptoms:

  • Paralysis or weakness on one side of the body
  • Numbness or tingling on one side of the body
  • Difficulty understanding others
  • Slurred or garbled speech
  • Sudden blindness in one eye
  • Drooping of one side of the face

If you have these symptoms and they go away, you still need to contact your healthcare provider as soon as possible. You could be experiencing a TIA.

Diagnosis

If your healthcare provider suspects you have carotid artery disease, your evaluation will consist of a medical history, an exam and tests to confirm the problem. Tests include a special ultrasound of the neck called a carotid artery duplex scan. This not only screens for carotid artery disease but also, if present, can check the amount of blockage. Ultrasound is a noninvasive test using harmless sound waves to create images. Ultrasound may be the only test you need but in some cases, additional imaging tests may be helpful. A CT (computed tomography), MRI (magnetic resonance imaging) and angiography may be used to take pictures of the brain. CT or MRI can also check the brain for signs of a previous stroke.

Treatment

A stroke is a serious problem. This is why your healthcare provider will suggest treatment if your tests show that it is needed. Two procedures are available to treat carotid artery stenosis.

The first and most common treatment is carotid endarterectomy. This procedure is an open surgery to remove plaque from the artery. An incision is made in the skin on your neck over the artery. The artery is opened and the plaque is removed. The incisions in the artery and the skin are then closed. You may be asleep under general anesthesia during surgery, or awake with local anesthesia to control pain. This surgery has very low risk of stroke or complications. It typically involves a quick recovery with little pain.

The second procedure for treating carotid artery disease is carotid angioplasty and stenting. This “minimally invasive” procedure improves blood flow to the brain. During the procedure, a long thin tube called a catheter is used to place the stent in the artery. (A stent is a flexible wire mesh tube.) This procedure uses local anesthetic. You will be awake during the entire time because your doctor will need to talk to you. Even though an artery in your neck is being treated, all of the activity takes place through your leg. The catheter is inserted into the femoral artery, a major artery in the groin. It is threaded through the arteries to the narrowed or blocked carotid artery. A tiny balloon is inserted and inflated to open up the area. The stent is then placed to keep the artery open and prevent it from narrowing again. You will most likely stay one or two days in the hospital and your recovery at home should take about a week.

There are pros and cons to both procedures and you may be a better candidate for one over the other. Be sure to discuss all of your options and concerns with your healthcare provider.

Controlling Arterial Disease

Keep in mind that these procedures do not cure arterial disease. This slow but steady process must be controlled by changing your lifestyle and taking medications. The same factors that put you at risk of stroke also put you at risk for other health problems. These include heart attack, kidney problems and other types of arterial disease. Lifestyle changes and medications can help treat these risk factors and keep you healthier.

Lifestyle Changes

Poor diet, lack of exercise and smoking contribute greatly to the development of arterial disease.

  • Diet: Although debates about the best diet are endless and many beliefs exist, some general guidelines are helpful to understand. Lower the fatty foods you eat because they contain high amounts of cholesterol. Limit foods with low nutritional value, such as sodas and over-refined carbohydrates. A diet high in fiber with many fruits and vegetables and limited in fats is best. It may be worthwhile to talk with a dietician or nutritionist about your eating habits to identify things that would be worth changing.
  • Exercise: Regular, low intensity exercises that increase breathing and raise your heart rate are not harmful and can contribute to the success of your treatment of carotid artery disease. Generally, the more you exercise, the better your body learns to use the oxygen that the heart delivers. The heart can then do its job more efficiently. This is known as “being in shape.” Your exercise routine should be fun, affordable, safe and at an appropriate level. There are many different published guidelines on how much exercise is best. Always check with your healthcare provider before starting any exercise program. Talk to your clinician about how much exercise to do. A general guideline is that you should still be able to carry on a conversation while you are exercising. If you cannot, it may be too strenuous.
  • Smoking: Smoking is a major risk factor in the development of arterial disease, as well as heart attacks and strokes. If you smoke, quit. Talk to your healthcare provider if you need help doing this.

Medications

You may be prescribed medications to help control blood cholesterol, diabetes and high blood pressure (hypertension). Controlling these problems can improve the health of your arteries. You may also need medications to prevent blood clots. It is important to take your medications as directed. Always check with your healthcare provider before stopping any medication.

When to Call Your Healthcare Provider

  • Call 911 (or your local emergency number) if you think that you or someone else is having a stroke or TIA.
  • Call if you experience mental confusion or headaches.

What We Have Learned

Carotid artery disease increases your chances of having a stroke.
True or False
The answer is True.

A stroke may be the first symptom of carotid artery disease.
True or False
The answer is True.

You can help control carotid artery disease through lifestyle changes and medications.
True or False
The answer is True.

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