Carotid Artery Disease

What is carotid artery disease?

Carotid artery disease is disease of the main arteries that carry oxygenated blood to the brain. Most commonly narrowing of these vessels is the result of accumulation of atherosclerosis plaque and is referred to as carotid stenosis. Carotid stenosis may be asymptomatic or may cause symptoms as cholesterol plaque can rupture and obstruct the carotid artery or break off traveling
up to obstruct arteries of the brain (emboli). These emboli to the cerebral arteries cause transient symptoms (TIA) or a stroke.

What are the risk factors for carotid artery disease?

Atherosclerosis is thought to play an important role in the development of carotid artery disease. The major risk factors for carotid artery disease are the same ones that are associated with coronary artery disease (CAD) which include: older age, male gender, family history, race, high cholesterol, hypertension (high blood pressure), smoking, diabetes, and obesity. Although these risk factors increase a persons risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. The more risk factors you have though, the more likely you are to get the disease. However, if you have one or more risk factors, you can take steps to help prevent the disease.

What causes carotid artery disease?

Atherosclerosis is the most common cause of carotid artery disease. Atherosclerosis plaque can slowly accumulate and the process may start as early as childhood. This process has the potential to progress rapidly. Plaque is made up of deposits of smooth muscle cells, fatty substances, cholesterol, calcium, and cellular waste products. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to the brain.

How does symptomatic carotid stenosis present?

Symptomatic carotid artery disease may result in either a transient ischemic attack (TIA) or a stroke. A transient ischemic attack is a sudden and temporary loss of blood flow to an area of the brain, lasting no longer than 24 hours with complete recovery. A stroke on the other hand results in lasting symptoms. Symptoms can include numbness or loss of feeling in the face, arm or leg, sudden weakness or inability to move an arm and/or leg, inability to speak clearly or slurred speech, loss of coordination or gait stability, confusion or dizziness, or temporary loss of vision or blurred vision.

Immediately call 911 if you suspect yourself or someone else is having a TIA or stroke as brain cells begin to die after just a few minutes without blood or oxygen.

How is carotid artery disease diagnosed?

In addition to a complete medical history and physical examination, a number of diagnostic tests assist in diagnosing carotid artery disease. Carotid stenosis is usually diagnosed by Doppler ultrasound scanning of the neck arteries. This involves no radiation, needles, or contrast agents. Occasionally further imaging is required which include CT angiography, standard angiography, and magnetic resonance angiography (MRA). Each imaging modality has its advantages and disadvantages.

How is carotid stenosis treated?

Specific treatment for carotid artery disease will depend on symptoms, findings on imaging, age, overall health, and medical history. Carotid artery disease (asymptomatic or symptomatic) in which the narrowing of the carotid artery is less than 50 percent is treated medically. Asymptomatic disease with less than 80 percent narrowing is also treated medically. Medical treatment for carotid artery disease should focus on risk factor modification including smoking cessation and maximal control of blood pressure, diabetes, and elevated cholesterol levels. When the blockage is severe (asymptomatic or symptomatic >80%) or deemed to be significant with associated symptoms, surgery is generally recommended. The standard approach is the carotid endarterectomy (CEA), which removes the cholesterol plaque from the carotid arteries.