Carotid Artery Disease, Stroke, and Transient Ischemic Attacks (TIAs)

Stroke is a leading cause of death and disability in the United States. It is estimated that 80 percent of strokes are preventable. A stroke occurs when a portion of the brain dies because it does not get enough blood. This usually occurs from narrowing of the carotid arteries, small pieces of plaque or clots that travel into the small arteries in the brain, blocking the blood flow. If you have significant narrowing in your carotid artery from peripheral artery disease (PAD), you may need the narrowing repaired for to reduce your risk of stroke.

What is carotid artery disease?

Carotid artery disease occurs when the major arteries in the neck become narrowed or blocked. These arteries, called the carotid arteries, supply the brain with blood. The carotid arteries extend from your aorta in your chest to your brain.

These arteries are normally smooth and unobstructed on the inside but, with age, plaque can build up in the walls of the arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, the arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries.

Symptoms

Weakness, Numbness, or Tingling

Feeling weakness, numbness, or a tingling sensation on one side of your body, for example, in an arm or a leg.

Loss of Limb Control

Being unable to control the movement of an arm or leg, for any duration.

Loss of Vision

Losing vision in one eye, often described as “a window shade coming down.”

Issues with Speech

Being unable to speak clearly.

Diagnosis

Examination

A complete physical examination and history.

Carotid Duplex Ultrasound

Carotid duplex ultrasound can detect most cases of carotid artery disease and can be performed in the office.

CT Scan and CT Angiography (CTA)

CT and CTA scans take pictures in the form of slices of the brain and the arteries in your neck.

Magnetic Resonance Angiography (MRA)

MRA uses radio waves and magnetic fields to create detailed images. This test may help evaluate carotid artery disease.

Treatments

Medical management often consists of smoking cessation, blood pressure, and cholesterol control. In addition to this, an anti-platelet agent like Aspirin may be prescribed.

In a carotid endarterectomy, an incision is made in the neck. Plaque contained in the inner lining of the carotid artery is removed and the artery is closed with a patch. You may be able to leave the hospital as early as the day after the procedure.

A minimally invasive procedure to treat carotid artery disease is angioplasty and stenting. Angioplasty and stenting is usually performed using a local anesthetic. To perform this procedure, a long, thin tube called a catheter is inserted through a small puncture site over a groin artery. The catheter is passed and is guided through the blood vessels to the carotid artery. A picture is then taken of the blockage, and a stent is placed in the blocked artery as needed.

Risks of Operation

Risks of carotid endarterectomy include bleeding, infection, small risk of stroke, risk of nerve damage, myocardial infarction, and very small risk of death. Risks of carotid artery stenting include bleeding, stroke, renal failure, myocardial infarction, and very small risk of death.