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Carotid Artery Disease

Carotid Artery Disease

Carotid (ka-ROT-id) artery disease, which can lead to a stroke, is a condition in which a fatty material called plaque builds up inside the carotid arteries. You have two common carotid arteries-one on each side of your neck-that divide into internal and external carotid arteries.The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck. Carotid artery disease can be very serious because it can cause a stroke, or "brain attack." A stroke occurs when blood flow to your brain is cut off. If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control. A stroke can cause lasting brain damage, long-term disability, paralysis (an inability to move), or death.

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SYMPTOMS

Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks the carotid arteries. Signs and symptoms may include a bruit (broo-E), a transient ischemic attack (TIA), or a stroke.

BRUIT

During a physical exam, your doctor may listen to your carotid arteries with a stethoscope. He or she may hear a whooshing sound called a bruit. This sound may suggest changed or reduced blood flow due to plaque. To find out more, your doctor may order tests. Not all people who have carotid artery disease have bruits.

TRANSIENT ISCHEMIC ATTACK

For some people, having a TIA, or "mini-stroke," is the first sign of carotid artery disease. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours. The symptoms may include:

  • Sudden weakness or numbness in the face or limbs, often on just one side of the body
  • The inability to move one or more of your limbs
  • Trouble speaking and understanding
  • Sudden trouble seeing in one or both eyes
  • Dizziness or loss of balance
  • A sudden, severe headache with no known cause
  • Even if the symptoms stop quickly, you should see a doctor right away. Call 9-1-1 (don't drive yourself to the hospital). It's important to get checked and to get treatment started within 1 hour of having symptoms.

A mini-stroke is a warning sign that you're at high risk of having a stroke. You shouldn't ignore these symptoms. About one-third of people who have mini-strokes will have strokes if they don't get treatment.

Although a mini-stroke may warn of a stroke, it doesn't predict when a stroke will happen. A stroke may occur days, weeks, or even months after a mini-stroke. In about half of the cases of strokes that follow a TIA, the stroke occurs within one year.

STROKE

Most people who have carotid artery disease don't have mini-strokes before they have strokes. The symptoms of stroke are the same as those of mini-stroke, but the results are not. A stroke can cause lasting brain damage, long-term disability, paralysis, or even death.

Getting treatment for a stroke right away is very important. You have the best chance for full recovery if treatment to open a blocked artery is given within 6 hours of symptom onset. Ideally, treatment should be given within 3 hours of symptom onset.

Call 9-1-1 as soon as symptoms occur (don't drive yourself to the hospital). It's very important to get checked and to get treatment started within 1 hour of having symptoms.

Make those close to you aware of stroke symptoms and the need for urgent action. Learning the signs and symptoms of a stroke will allow you to help yourself or someone close to you lower the risk for damage or death from a stroke.

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CAUSES & RISK FACTORS

You may need a medical procedure to treat carotid artery disease. Doctors use one of two methods to open narrowed or blocked carotid arteries.

Carotid artery disease appears to start when damage occurs to the inner layers of the carotid arteries. Major factors that contribute to damage include: 

  • Smoking
  • High amounts of certain fats and cholesterol in the blood
  • High blood pressure
  • High amounts of sugar in the blood due to insulin resistance or diabetes

 When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

Over time, the plaque may crack. Blood cells called platelets stick to the injured lining of the artery and may clump together to form blood clots.

The buildup of plaque or blood clots can severely narrow or block the carotid arteries. This limits the flow of oxygen-rich blood to your brain and can cause a stroke.

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DIAGNOSIS

Your doctor will diagnose carotid artery disease based on your medical history and the results from a physical exam and tests.

MEDICAL HISTORY

Your doctor will find out whether you have any of the major risk factors for carotid artery disease. He or she also will ask whether you've had any signs or symptoms of a mini-stroke or stroke.

PHYSICAL EXAM

To check your carotid arteries, your doctor will listen to them with a stethoscope. He or she will listen for a whooshing sound called a bruit. This sound may indicate changed or reduced blood flow due to plaque. To find out more, your doctor may order tests.

DIAGNOSTIC TESTS

The following tests are common for diagnosing carotid artery disease. If you have symptoms of a mini-stroke or stroke, your doctor may use other tests as well.

  • Carotid Ultrasound: Carotid ultrasound (also called sonography) is the most common test for diagnosing carotid artery disease. It's a painless, harmless test that uses sound waves to create pictures of the insides of your carotid arteries. This test can show whether plaque has narrowed your carotid arteries and how narrow they are.
  • A standard carotid ultrasound shows the structure of your carotid arteries. A Doppler carotid ultrasound shows how blood moves through your blood vessels.
  • Carotid Angiography: Carotid angiography (an-jee-OG-ra-fee) is a special type of x ray. This test may be used if the ultrasound results are unclear or don't give your doctor enough information. For this test, your doctor will inject a special substance (called contrast dye) into a vein, most often in your leg. The dye travels to your carotid arteries and highlights them on x-ray pictures.
  • Magnetic Resonance Angiography: Magnetic resonance angiography (MRA) uses a large magnet and radio waves to take pictures of your carotid arteries. Your doctor can see these pictures on a computer screen. For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.
  • Computed Tomography Angiography: Computed tomography (to-MOG-rah-fee), or CT, angiography takes x-ray pictures of the body from many angles. A computer combines the pictures into two- and three-dimensional images. For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.

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TREATMENT OPTIONS

Medicines

You may need medicines to treat diseases and conditions that damage the carotid arteries. High blood pressure, high blood cholesterol, and diabetes can worsen carotid artery disease. Some people can control these problems with lifestyle changes. Others also need medicines to achieve and maintain control.

You may need antiplatelet (an-ty- PLATE-lit) medicines to prevent blood clots from forming in your carotid arteries and causing a stroke. Damage and plaque buildup make blood clots more likely.

Aspirin and clopidogrel are two common antiplatelet medicines. They stop platelets from clumping together to form clots. These medicines are a mainstay of treatment for people who have known carotid artery disease.

Your health care team will help find a treatment plan that's right for you. Sticking to this plan will help avoid further harm to your carotid arteries.

Procedures

You may need a medical procedure to treat carotid artery disease. Doctors use one of two methods to open narrowed or blocked carotid arteries.

  • Carotid Endarterectomy: This treatment is mainly for people whose carotid arteries are blocked 50 percent or more. For the procedure, a surgeon will make a cut in your neck to reach the narrowed or blocked carotid artery. He or she will make a cut in the artery and remove the plaque inside. The artery and your neck will then be stitched up.
  • Carotid Artery Angioplasty and Stenting: Doctors use a procedure called angioplasty (AN-jee-oh-plas-tee) to widen the carotid arteries and restore blood flow to the brain. A thin tube with a balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. A stent (a small mesh tube) is then put in the artery to hold the plaque back and keep the artery open.

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Babu, Sateesh
Babu, Sateesh
Chief, Vascular Surgery
Vascular Surgery
Laskowski, Igor
Laskowski, Igor
Chief, Endovascular Surgery
Vascular Surgery
Carroll, Francis X.
Thoracic Surgery
Vascular Surgery
Goyal, Arun
Vascular Surgery
Mateo, Romeo B.
Vascular Surgery
Shah, Pravin M.
Vascular Surgery