Carotid Disease


What is carotid?
Carotid arteries are the main blood vessels that take blood to the brain. They are two, and are located in the neck.


What is carotid artery disease?
Carotid artery disease, also known as “carotid artery atherosclerosis”, occurs when fatty deposits called plaque build up inside the carotid arteries. When plaque forms in these arteries, they become narrow. 


What are the symptoms of carotid artery disease?
Carotid artery disease does not usually cause symptoms. People with carotid artery disease are at greater risk of having a stroke.


What is stroke?
Stroke, known by doctors as cerebrovascular accident (CVA), occurs when part of the brain dies because it goes without blood and oxygen for too long. Carotid artery disease can lead to strokes, because blood clots can form inside the narrowed artery. The clots and other material from the fatty plaque can travel to the brain, clog smaller arteries and cause a stroke. Some people recover from strokes without lasting effects or with only minor problems. But many people have serious problems after a stroke. After a stroke, some people are:
 
  • Unable to speak or understand speech
  • Paralyzed on one half of their body
  • Unable to dress, feed, or take care of themselves

There is a special kind of stroke that is called “transient ischemic attack” or TIA. They are basically strokes that last less than 24 hours. TIAs happen when a blood vessel in the brain gets clogged briefly and then reopens. People who have TIAs can have the symptoms of a stroke, but the symptoms go away in a short time. People who have TIAs are at very high risk of having a full-blown stroke.


Is there a test for carotid artery disease?
Yes. Vascular surgeons can listen to each carotid artery with a stethoscope. They do this to check for a swishing sound that occurs when the artery is partly blocked. To confirm carotid artery disease and evaluate its severity, vascular surgeons can ask for the following exams:
 
  • Duplex ultrasound – visualizes carotid arteries and gives the percentage of narrowing.
     
  • Magnetic resonance imaging – uses a magnet to visualize carotid arteries and estimate the percentage of narrowing. It requires an injection of a chemical in the arm vein, that makes the vessels show up more clearly.
     
  • Computed tomography – uses X-ray to visualize carotid arteries and estimate the percentage of narrowing. Also requires an injection of a chemical in the arm vein.
     
  • Angiography - uses X-ray and a chemical injected directly in the carotid arteries.

How is carotid artery disease treated?
Treatments for carotid artery disease focus mostly on preventing stroke. Treatments can include:
 
  • Lifestyle changes – people can reduce their risk of stroke by:

               -Quitting smoking
               -Being active
               -Loosing weight if they are overweight
               -Eating a diet low in fat
 
  • Medicines – different people need different medicines to reduce their chances of having a stroke. In general, the medicines that can help prevent strokes include:

              -Medicines to lower blood pressure
              -Medicines called statins, which lower cholesterol
              -Medicines to prevent blood clots, such as aspirin
 
  • Surgery – vascular surgeons can do surgery to remove the plaque that causes carotid artery narrowing. This is called “carotid endarterectomy.” This treatment is most appropriate for people who have a lot of plaque that cause tight narrowing in their carotid arteries. This surgery works well for those who have had and for those who have not had a stroke or TIA.
     
  • Stenting – is when doctors insert a tiny metal tube called a “stent” into the carotid artery. The stent is designed to prop open narrowed arteries. It is inserted through a small cut in the groin. Beside it dos not require a cut in the neck, this treatment seems to be more dangerous than surgery, especially for people age 70 or older. It is not appropriate for most people.

Which is the best treatment?
The best treatment depends on each case. The best option for one case may not be the best for others. The choice will depend on:
 
  • How much the carotid artery is narrowed by plaque
  • Patients age
  • Whether the patient is a man or a woman
  • Whether the patient have other health problems besides carotid artery disease

If the vascular surgeon suggests surgery or stenting, it is important to ask these questions:
 
  • What are the chances that I will have a stroke in the next 5 years if I DO NOT have this procedure? What if I DO have?
  • What are the risks of the procedure?
  • Does the surgeon who will do the procedure have experience?

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