The carotid arteries extend from a large artery in your chest, called the aorta, to the brain inside your skull. There are two carotid arteries, one on either side of the neck. As a person ages, plaque can begin to build up within the arteries, causing them to narrow and stiffen. These plaque deposits are often irregular, so often blood clots can collect in these narrowed areas. This can narrow the space further or cause a complete blockage, resulting in decreased blood flow and oxygen supply to the brain, which can cause a mini-stroke called a TIA, or a stroke.
Why Do I Have Carotid Artery Disease?
As someone ages, they are at higher risk of developing what is known as atherosclerosis, or hardening of the arteries. Basically plaque builds up on the inner walls of your arteries, when low-density lipoproteins, the bad type of cholesterol referred to as LDL, invades the artery wall. Muscle cells in the wall of the artery overgrow and fat and calcium starts to build up within these irregular spaces. Bleeding into the artery wall can also occur, resulting in formation of a clot that narrows the opening of the blood vessel even further.
There are many factors that can contribute to putting someone at risk of developing peripheral vascular disease:
- Age greater than 50
- Male gender
- Diabetes or impaired glucose tolerance
- Postmenopausal women
- Family history of high cholesterol, high blood pressure, carotid artery disease, or peripheral vascular disease
- Family history of stroke
- Coronary artery disease or heart disease
- High cholesterol
- High blood pressure
- Obesity or physical inactivity
- Smoking or use of tobacco products
How Is A Stroke Diagnosed?
Diagnosis is made by combination of physical examination, report of symptoms, and diagnostic testing. Unfortunately, the first sign of this disease may be a stroke or warning signs called a mini-stroke or TIA. These symptoms usually last for a few minutes or up to an hour before going away, whereas stroke symptoms will not subside quickly. Someone experiencing these symptoms should call 911 right away or have someone take them to the ER:
- Weakness, numbness, or tingling on one side of the body, often in an arm or a leg
- Paralysis or loss of coordination on one side of the body
- Drooping on one side of the face or by the mouth
- Blindness or change in vision in one eye
- Loss of balance
- Loss of speech or garbled, slurred speech, difficulty using tongue
- Inability to write or understand writing
- Memory loss or confusion
- Loss of consciousness or “black out”
Tests to confirm diagnosis include:
- Carotid artery duplex ultrasound
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
- Computed tomography scan (CT)
- Angiogram or arteriogram
What Are My Treatment Options for Carotid Artery Disease?
Treatment depends upon the stage of the disease itself and whether you are experiencing symptoms from the disease. Medications and lifestyle modifications are the first step in early disease, with minimally invasive and surgical intervention being considered once the disease has become severe.
Lifestyle modifications would include quitting smoking, trying to maintain a healthier weight and getting regular exercise. Also, it is very important to control other risk factors, by taking the appropriate prescribed medications to control blood pressure, cholesterol, and diabetes. Aspirin may be added to thin your blood and statins to help prevent further plaque buildup in your arteries from high cholesterol.
Other interventions are considered once carotid artery disease has progressed to a severe stage. This would mean you are having TIA symptoms, you have had a stroke in the past, or one of the carotid arteries is severely narrowed, with or without symptoms. These interventions include the following:
- Carotid angioplasty and stenting: this is a minimally invasive procedure that involves inserting a long, thin flexible tube called a catheter through a small puncture over an artery in your groin. Under x-ray guidance, this catheter is directed through the blood vessels to the affected carotid artery. The surgeon will inject contrast dye through the catheter while taking an x-ray picture to determine the extent and location of the blockage. A special balloon at the end of the catheter is inflated and deflated several times in order to compress the plaque against the walls of the artery. This widens the opening of the blood vessel, so blood is able to flow freely through it. The surgeon will then place a mesh-like metal tube called a stent within the artery to keep it open. This is generally performed using local anesthetic and requires a short hospital stay of 1 day.
- Carotid Endarterectomy: An incision is made on the affected side of the neck and the plaque is removed from the inner lining of the carotid artery. Depending on the extent of disease to the artery, a patch of material may be sewn in place to make up for the lack of healthy artery when it is sewn back together. The blood flow is fully restored to the brain following the procedure. This requires a hospital stay of about 1 day.
How Can I Prevent a Stroke from Happening?
Strokes result from either hemorrhage or ischemia in the brain. Hemorrhage in the brain results from arteriolar bleeding due to hypertension, coagulation disorders, cocaine and amphetamine abuse, and vascular malformations. Ischemia is the result of hypoperfusion of brain tissues due to either obstruction of the arterial, oxygenated supply of blood by thrombus or embolus or because of systemic circulatory problems such as heart failure. Prevention of stroke is through the addressing of these risk factors.
Prevention of Hemorrhagic Stroke:
- Control of hypertension via smoking cessation, exercise, weight management, and treatment with antihypertensives and statins
- Diagnose and treat bleeding disorders, if present
- Avoid of substance abuse, especially sympathomimetics and substances that act as vasoconstrictors, such as the nicotine in tobacco products
- Observe for warning signs of CNS vascular malformation, such as headache and transient ischemic attacks (TIAs)
- Aggressive surveillance if there is a blood disorder such as sickle cell anemia, protein deficiency, antiphospholipid syndrome, etc
- Strict glycemic control in diabetics
Prevention of Ischemic Stroke:
- Control of hypertension via smoking cessation, weight management, and treatment with antihypertensives and statins
- Strict surveillance of the carotid circulation in patients with hypertension, diabetes, dyslipidemia, or a strong family history of deep vein thrombosis or pulmonary emboli
- Aggressive diagnostics (imaging) after TIA
- Address any hypercoagulable state to discourage thrombus formation
- Smoking cessation, weight management
- Avoid excessive alcohol intake
- Low-dose daily aspirin for those ≥50 years without excess bleeding risk
Prevention of a Second Stroke (Secondary Prevention):
- Anti-platelet therapy by aspirin or clopidogrel (Plavix) for the prevention of thrombus formation and to safeguard a patient from complications (emboli) of atrial fibrillation.
- Use of anti-diabetic medication to reduce insulin resistance