Carotid Artery Disease - Stroke Prevention
At Mount Sinai, our team of vascular surgeons and interventional cardiologists uses a collaborative approach to diagnose, treat, and provide follow-up care for carotid artery disease and stroke prevention. We pride ourselves on working with you and your family to develop the best possible approach to meet your needs.
About Carotid Arteries
You have two carotid arteries, which supply oxygenated blood to the brain, traveling through the front of the neck. Blockages in these arteries can cause stroke and significant damage to the brain.
Blockages usually stem from carotid artery stenosis, which is the narrowing of the carotid arteries generally caused by deposits of cholesterol, fat, and other substances (atherosclerosis). These substances accumulate in the blood vessel walls over several years and form a material called plaque. As plaque builds up, small pieces can break off and travel to the brain and cause stroke. Carotid stenosis is responsible for about 30 percent of stroke cases.
There are several factors that can increase one's risk of carotid artery disease and stroke, including:
- Family history of stroke or heart attack
- High blood pressure (hypertension)
- High-fat diet
When the disease is in its early stages, you probably won’t experience any symptoms. The disease is often not identified until we hear a sound called a bruit when we listen to your chest.
You can decrease your chances of having a stroke by making some lifestyle changes, such as:
- Being physically active each day
- Lowering high blood pressure
- Maintaining a healthy body weight and eating healthy diet
- Quitting smoking
- Reducing high cholesterol
A stroke is similar to a heart attack. It happens when your brain is not receiving oxygen, due to clots from the carotid or other artery. A transient ischemic attack (TIA) is like a mini-stroke, and lasts only a few minutes.
If you experience any of these stroke symptoms, seek immediate medical attention:
- Difficulty swallowing
- Dizziness or confusion
- Loss of coordination
- Slurred speech, difficulty talking or understanding what others are saying, inability to comprehend
- Sudden loss of vision or blurred vision in one or both eyes
- Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
Diagnosis and Treatment
If your doctor suspects you have carotid artery disease, we start by taking your medical history and conducting a physical exam. Imaging tests can help us collect more information. Our experts are most likely to perform one or more of these tests:
- Carotid ultrasounds (sonograms) use 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 (CT) angiography is a two-step process. First we take X-ray pictures of your body from many angles, then a computer combines the pictures into two- and three-dimensional images.
- Magnetic resonance angiography (MRA) uses a large magnet and radio waves to take pictures of your carotid arteries. We may give you contrast dye to help us see your carotid arteries.
- Carotid angiography involves injecting dye into your arteries using a narrow tube (catheter), then taking guided X-rays.
In general, we use medicine or surgery to treat calcium build-up (atherosclerosis) and carotid artery disease. Medical therapy can include anticoagulants, antiplatelets, and statins.
Surgical treatments offered at Mount Sinai include:
- Stenting (angioplasty) involves inserting a metal stent to help keep the artery expanded. We tend to use this approach only if you are not a good candidate for conventional surgery.
- Carotid endarterectomy is removing the plaque that is narrowing your artery through an incision in the neck. After we remove the plaque, we close the artery with a synthetic patch.