Carotid Artery Disease

Carotid Artery Disease StatisticsCarotid arteryCarotid artery disease is defined by the narrowing or blockage of the carotid artery due to the build-up of plaque (which is a deposit of cholesterol, calcium, and other cells in the artery wall). The carotid arteries are on each side of your neck and carry oxygen-rich blood from your heart to your head and brain.

Over time, this narrowing may eventually become so severe that a blockage decreases blood flow to the brain and might tragically cause a stroke. A stroke can also occur if a piece of plaque or a blood clot breaks off from the wall of the carotid artery and travels to the smaller arteries of the brain.
The brain survives on a continuous supply of oxygen and glucose carried to it by blood. Cells deprived of fresh blood for more than a few minutes will be damaged, a condition known as "ischemia," or the brain cells may die, a condition known as "infarction." When blood flow to the brain is blocked, the result is sometimes called "an ischemic event." This could be a stroke, which is permanent loss of brain function, or a "transient ischemic attack" (or TIA), which implies a temporary alteration of brain function. Brain damage can be permanent if this lack of blood flow lasts for more than 3 to 6 hours.

Causes

The risk factors for carotid artery disease are similar to the risk factors for PAD and coronary heart disease. They include:

  • Family history of atherosclerosis (build-up of plaque in the peripheral, coronary or carotid arteries)
  • Age (Men have a higher risk before age 75. Women have a higher risk after age 75.)
  • Smoking
  • Hypertension
  • Diabetes
  • High cholesterol, and especially high amounts of "low density lipoprotein" (or LDL, the bad form of cholesterol)

Most importantly, if you have an atherosclerotic artery disease such as PAD or coronary heart disease, you are at high risk for carotid artery disease and stroke.

Warning Signs

As for all artery diseases, often there are no symptoms for carotid artery disease in its early stages. Unfortunately, the first obvious sign could be a transient ischemic attack (TIA) or mini-stroke or even a stroke. Symptoms for a stroke or TIA are similar and may include the following:

  • confusion, trouble speaking or understanding
  • blurring, dimming, or loss of vision
  • the inability to normally move an arm or leg
  • weakness, numbness or a tingling sensation in a part of the body, such as the face, an arm or a leg especially on one side of the body
  • trouble walking, dizziness, loss of balance or coordination
  • a sudden severe headache

The difference between a stroke and a TIA is that the symptoms of a TIA are not permanent and can last from a few minutes to 24 hours. A TIA is a very powerful warning sign that you are at serious risk of a stroke in the near future. A TIA, like stroke, should be treated as a medical emergency.

Treatment & Prevention

If you have any degree of narrowing of a carotid artery or any history of stroke or TIA, you should quit the use of all tobacco products immediately, control your high blood pressure, normalize your blood cholesterol by diet and medications, lose weight if overweight, and exercise regularly. Treatments for carotid artery disease include the following:

Medications: Several medications may be prescribed to prevent further progression of the disease and to reduce the effect of contributing factors such as high blood pressure, and high cholesterol and diabete.

Endovascular procedureEndovascular treatments are the least invasive and involve inserting a catheter into the artery in the groin and guiding it through your blood vessels to the carotid artery. Angioplasty may be done to open blockages by using a small balloon introduced with a catheter into an artery. The balloon is inflated and, as it inflates, it stretches and opens the artery for improved blood flow. A metallic device called a “stent” can then be inserted to maintain the expanded artery, thereby improving blood flow to the limb. This procedure’s safety and efficacy continues to be studied in several medical centers. Other treatments include laser atherectomy, where small bits of plaque are vaporized by the tip of a laser probe, and directional atherectomy, in which a catheter with a rotating cutting blad is used to physically remove plaque from the artery.

Surgery may be recommended for individuals with severe blockages of the carotid artery (usually at least 60 - 70 percent blockage). This procedure, called a carotid endarterectomy, removes the plaque from inside the artery wall and restores the blood flow to normal. Generally, it is performed through a small incision and, in many cases, under regional anesthesia.

Resources

National Institutes of Health

Vascular Disease Foundation

Mayo Clinic