Carotid Artery Disease and Stroke
Carotid arteries are major arteries supplying blow flow to the brain one on either side, respectively and provide oxygen. These arteries travel in the neck and supply the brain with their three main branches. Blockages in these arteries can cause stroke and significant damage to the brain.
Carotid artery stenosis is the narrowing of the carotid arteries, usually caused by cholesterol deposits (atherosclerosis). Atherosclerosis is deposition of cholesterol, fat, and other substances traveling through the bloodstream, such as inflammatory cells, cellular waste products, proteins, and calcium. These substances accumulate in the blood vessel walls over the years and combine to form a material called plaque when people age. Buildup of plaque can lead to narrowing or blockage in the carotid artery, which can put an individual at increased risk for stroke. Carotid stenosis is responsible for about 30 percent of stroke cases. The prevalence of carotid stenosis varies with age and other risk factors, such as cigarette smoking and a high-fat diet.
Carotid Artery Disease Risk Factors
There are several factors that can increase one's risk of carotid artery disease and stroke, including:
- High blood pressure (hypertension)
- Family history of stroke or heart attack
- Age: Men under age 75 have a greater risk of developing carotid artery disease than women, but, after age 75, women have a greater risk than men
Carotid Artery Disease Symptoms
Carotid artery disease can occur without any symptoms and not present itself until a physician hears a bruit (audible vascular sound associated with turbulent blood flow), transient ischemic attack (TIA), or a stroke.
Symptoms of TIA or stroke include:
- Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
- Slurred speech, difficulty talking or understanding what others are saying, unable to comprehend.
- Sudden loss of vision or blurred vision in one or both eyes
- Loss of coordination
- Dizziness or confusion
- Difficulty swallowing
Emergent treatment for TIA or stroke is very important as it can cause severe disability to the patient. The success of treatment is higher if the blocked artery is opened with four hours of the symptom onset. As soon as any symptoms occur, call 9-1-1.
Diagnosing Carotid Artery Disease
A physician can identify carotid artery disease based on various factors, including:
- Medical history: Smoking history, hypertension, diabetes mellitus, prior stroke / TIA, obesity, and family history puts raises the risk for carotid artery disease
- Physical exam: The presence of bruit alerts the physician to check for carotid artery disease
- Diagnostic tests: The following tests are common for diagnosing carotid artery disease
- Carotid angiography happens a physician inserts a catheter from the groin or arm and injects dye to identify blockage and its severity in this procedure.
- Carotid ultrasound (sonogram) is the most common test for diagnosing carotid artery disease. It's a painless, harmless test that uses sound waves to form pictures of your carotid arteries. This test can show the severity of the plaque in your carotid arteries and the percentage of narrowing.
- Computed tomography angiography occurs after a scanning machine takes x-ray pictures of the body from many angles – a computer combines the pictures into two- and three-dimensional images.
- Magnetic resonance angiography uses a large magnet and radio waves to take pictures of your carotid arteries. For this test, your doctor may give you contrast dye to visualize your carotid arteries on the pictures on the computer.
Carotid Artery Disease Treatments
Someone with carotid artery disease can minimize his or their risk of developing or worsening carotid artery disease that can lead to a stroke by making changes to their lifestyle, including:
- Quitting smoking
- Lowering high blood pressure
- Reducing high cholesterol
- Maintaining a healthy body weight and eating healthy diet
- Being physically active each day
Medical therapy, including anticoagulants, antiplatelets, and statins, can be prescribed to treat atherosclerosis and carotid artery disease.
In appropriate cases, minimally invasive or surgical procedures may be used to treat carotid artery disease. At The Mount Sinai Hospital, we have use collaborative approach with an extensive discussion of the patient with both the vascular surgeon and interventional cardiologist to come to a best possible treatment for the patient. Surgical treatments offered at Mount Sinai include:
- Angioplasty and stenting which involve a metal stent inserted to help keep the artery expanded. Angioplasty and stents are recommended only for patients who are not candidates for conventional surgery because their high risk of stroke during the procedures.
- Carotid endarterectomy involves an incision in the neck to open the artery and remove the plaque that is causing the narrowing. After the plaque is removed, the surgeon closes the artery with a synthetic patch. Carotid endarterectomy is an option for those patients who have comorbities like blockages in the heart arteries and technically challenging blockages.