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

Carotid artery disease develops when the carotid arteries become hardened and narrowed. The carotid arteries run from the aorta in the chest, up each side of the neck, and to the base of the skull. These arteries are essential for blood flow to the brain.

As you age, it is not uncommon for plaque (a gummy substance made of cholesterol, calcium, and fibrous tissue) to build up on the inside of artery walls. As more plaque accumulates, the arteries begin to narrow and stiffen causing atherosclerosis, or hardening of the arteries. When enough plaque builds up to interfere with blood flow in your carotid arteries, carotid artery disease occurs. Carotid artery disease is much more common in patients of advanced age. Up to 10 percent of adults ages 80 to 89 have carotid artery disease, as opposed to only 1 percent of adults ages 50 to 59. If left untreated, carotid artery disease can lead to stroke.

Lifestyle changes may be able to prevent or slow down carotid artery disease. These include:

  • Quitting smoking
  • Maintaining a healthy weight
  • Eating a healthy diet low in saturated fat and calories
  • Controlling cholesterol levels, diabetes, and/or high blood pressure
  • Exercising regularly

Symptoms of Carotid Artery Disease

Early on, carotid artery disease may not exhibit any symptoms. Because of this, most patients do not seek treatment and, unfortunately, a stroke may be the first sign that something is wrong. Sometimes, transient ischemic attacks (TIAs) occur leading up to a stroke, which can alert your doctor that a stroke is imminent. A TIA typically lasts a couple minutes up to one hour.

Symptoms include:

  • Weakness, numbness, or tingling on one side of your body
  • Not being able to control the movement of an arm or a leg
  • Loss of vision in one eye or the sensation of a window shade closing in front of your eye
  • Speech loss or the inability to speak clearly

These symptoms are temporary and normally disappear completely within 24 hours. If the symptoms you are experiencing last longer than a few hours or do not resolve, it is likely a stroke. It is important to note that any of the above symptoms, however long they last, should be reported to your doctor immediately.

Causes & Risk Factors

The most common cause of carotid artery disease is atherosclerosis or hardening of the arteries. Though its cause is not fully understood, many believe that atherosclerosis develops when the arterial lining is damaged. Smoking, high cholesterol, and high blood pressure can all cause injury to the walls of the arteries.

Although rare, carotid artery disease can also be caused by conditions such as carotid aneurysm disease and fibromuscular dysplasia.

Risk factors for carotid artery disease include diabetes and having a family history of atherosclerosis.

Tests Used to Diagnose Carotid Artery Disease

If your doctor suspects that you have carotid artery disease, he or she will seek a diagnosis by surveying your general health, inquiring about your medical history and possible risk factors, and asking you to describe your symptoms and how often they occur. This discussion is typically followed by a physical exam, which may include a blood pressure test. Your doctor may also use a stethoscope to listen to the blood flow in the carotid arteries to determine if bruits, or unusual whooshing sounds, are present. If they are present, obstructed blood flow may be likely.

If these tests indicate that carotid artery disease is likely, further tests are needed to determine a firm diagnosis and to learn how much the disease has advanced. The most common diagnostic procedures include:

Duplex Ultrasound
A duplex ultrasound uses high-frequency sound waves and a computer to create images of blood vessels to assess the blood flow within the vessels and the structure of the vessels themselves. This is a painless, non-invasive procedure that uses no radiation and can help determine the exact arteries that are affected.

Most cases of carotid artery disease are diagnosed with duplex ultrasound. However, other tests may be needed to discover further information about your condition.

Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels.

Arteriography
Your doctor may perform one of three types of arteriography to further determine the exact location and extent of the damage. Arteriography helps to provide a more detailed roadmap as to where possible carotid artery disease is located.

MR Angiography (MRA) and CT Angiography (CTA) – MRA and CTA are imaging procedures that combine magnetic rays or X-rays and computer technology to produce detailed images of the blood vessels. Typically, MRA takes longer to perform than CTA. However, unlike CTA, it does not use radiation, so doctors may favor MRA for repeated follow-ups.

Contrast Arteriography (Arteriogram) – This is an invasive procedure that provides a more detailed view of the blood vessels and can determine the specific location of blockages. When performing an angiogram, a special dye (properly referred to as contrast) is injected into the blood vessels through a catheter, making arteries visible on an X-ray. During contrast arteriography, it is common for procedures such as angioplasty or stent repairs to be performed as well.

Treatments for Carotid Artery Disease

Based on the cause, location, and severity of your condition, the best course of treatment will be determined by your doctor. Your overall health will also be taken into account, and the first course of treatment may include lifestyle changes. If you smoke, the most worthwhile lifestyle change you can make is to quit. Your arteries may obtain further damage from the chemicals in tobacco, and your risk of complications from the disease may increase.

It is also important to stay active and exercise if possible. Eating a healthy, low-fat and high-fiber diet along with regular activity will help you maintain a normal weight. Simple lifestyle changes to diet and exercise may slow atherosclerosis.

For patients with carotid artery disease, it is important to manage all existing conditions, such as diabetes, high cholesterol, or high blood pressure, to lessen your risk of complications from the disease. If you have high cholesterol or high blood pressure, your doctor may prescribe medications to maintain normal levels and reduce the risk of developing complications from the disease. If you have diabetes, it is important to follow the diet your doctor recommends and to take any medications prescribed to help manage blood sugar levels.

Surgery
Patients with severe or progressive carotid artery disease, especially those experiencing TIAs or who have had a previous stroke, may need surgical treatment.

Surgical options include:

Carotid Endarterectomy – An endarterectomy is a procedure used to remove plaque buildup on the artery walls, which can restore blood flow and decrease the risk of clot, or emboli, traveling to your brain causing a TIA or stroke. During the procedure, your vascular surgeon opens the affected artery to remove the plaque buildup on the arterial lining and then repairs the artery with a stitch or graft.

Angioplasty – An angioplasty is a minimally invasive procedure that helps improve your circulation. During an angioplasty, a hollow needle will be inserted into your artery and a special balloon attached to a catheter will be threaded through the needle to reach the blockage within the blood vessel. Once this device reaches the desired location, the balloon is then repeatedly inflated and deflated to widen the artery walls. In some cases, a permanent stent (a tube made of metal mesh) is placed into the narrowed area of the artery to keep it open and allow for unobstructed blood flow.

Although conclusive results regarding the efficacy of carotid angioplasty and stenting are not yet available, the procedure has been approved as an alternative for patients with carotid artery disease who are at a high risk of developing complications from carotid endarterectomy. It has also been approved for patients who are participating in clinical studies to help determine the effectiveness of the procedure.

Staying Healthy with Carotid Artery Disease

Patients with mild to moderate carotid artery disease who do not require surgery must be sure to continue taking prescribed medications, such as blood thinners or statins. Additionally, you and your immediate family members must learn the signs and symptoms of TIA and stroke. Because carotid artery disease may progress over time, be sure to schedule regular visits and follow-up exams with your doctor.

Lifestyle changes and medications should be considered to reduce your risk of atherosclerosis or to limit the progression of carotid artery disease.

These include:

  • Quitting smoking
  • Maintaining a healthy weight 
  • Eating a healthy diet low in saturated fat and calories
  • Controlling cholesterol levels
  • Exercising regularly
  • Cholesterol-lowering medications and anti-platelet therapy

Carotid Artery Disease - Dr. Sarac

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