Carotid Artery Disease

The carotid arteries are large arteries on both sides of the neck that are the main blood supply to the brain. Carotid artery disease, also called carotid artery stenosis, is the narrowing or blockage of one or both carotid arteries due to atherosclerosis. Atherosclerosis is a disease in which plaque builds up on the inside of the carotid arteries. Plaque is made up of fats (lipids), cholesterol, calcium, and fibrous tissue. When blood flow in the carotid arteries is narrowed or blocked, it can put you at increased risk for a transient ischemic attack (TIA) or stroke. It is very important to get help right away if you develop TIA or stroke symptoms.

RISK FACTORS

Risk factors for developing atherosclerosis include:

  • High cholesterol (dyslipidemia).

  • High blood pressure (hypertension).

  • Smoking.

  • Obesity.

  • Diabetes.

  • Family history of cardiovascular disease.

  • Inactivity or lack of regular physical or aerobic exercise.

  • Gender. Men have an increased risk of developing atherosclerosis earlier in life than women.

Risk factors for a TIA or stroke include:

  • Coronary artery disease.

  • An abnormal heart rhythm (atrial fibrillation).

  • A heart defect such as atrial septal defect.

  • Smoking.

  • A diet high in saturated fat.

  • Previous history of a stroke.

  • Family history of a stroke.

  • Being over the age of 55.

  • Alcohol and drug abuse.

  • Being an African American.

  • Sickle cell disease.

SYMPTOMS

TIA or stroke symptoms can develop from carotid artery disease. A TIA is a temporary loss of blood flow to the brain and is considered a "warning stroke." TIA symptoms last less than 24 hours and go away completely. A stroke is the sudden death of brain tissue due to lack of blood flow within the brain. This can be caused by a clot (thrombus), bleeding (hemorrhage), or blockage of blood flow to or in the brain. A stroke can cause permanent damage that can affect speech, movement, and coordination. TIA or stroke symptoms include:

  • Sudden weakness or numbness on one side of the body, such as in the face, arm, or leg.

  • Sudden confusion.

  • Trouble speaking (aphasia) or understanding.

  • Sudden trouble seeing out of one or both eyes.

  • Sudden trouble walking.

  • Dizziness or feeling like you might faint.

  • Loss of balance or coordination.

  • Sudden severe headache with no known cause.

  • Sudden trouble swallowing (dysphagia).

DIAGNOSIS

Diagnosis of carotid artery disease may include:

  • A physical exam. Your caregiver may hear an abnormal sound (bruit) when listening to the carotid arteries.

  • Specific tests that look at the blood flow in the carotid arteries. These tests include:

  • Carotid artery ultrasonography.

  • Carotid or cerebral angiography.

  • Computerized tomographic angiography (CTA).

  • Magnetic resonance angiography (MRA).

TREATMENT

Treatment of carotid artery disease can include a combination of medicine, diet modification, lifestyle changes, and surgical intervention. Specific carotid artery disease treatment options include:

  • Surgical treatment:

  • A carotid endarterectomy. This is a surgery to remove the blockages in the carotid arteries.

  • A carotid angioplasty with stenting. This is a nonsurgical interventional procedure. A wire mesh (stent) is used to widen the blocked carotid arteries.

  • Medicines to control blood pressure, cholesterol, and reduce blood clotting (antiplatelet therapy).

  • Diet. It is important to eat a healthy diet that is low in saturated fats which includes plenty of fresh fruits, vegetables, and lean meats. Avoid high-fat, high-sodium foods as well as foods that are fried, overly processed, or have poor nutritional value.

  • Lifestyle changes such as:

  • Quitting smoking.

  • Exercising as tolerated or as directed by your caregiver.

  • Controlling and maintaining a good blood pressure.

  • Keeping cholesterol levels under control.

HOME CARE INSTRUCTIONS

  • Make sure you understand all your medicine instructions. Do not stop your medicines without talking to your caregiver. Medicine may be used to control conditions such as high blood pressure, high cholesterol, and diabetes. Aspirin or blood thinners may be used to "thin" the blood which can help prevent a stroke or TIA.

  • Follow your caregiver's diet instructions. Certain diets may be used to manage high blood pressure, high cholesterol, diabetes, or obesity. Many of the diets include reduced calories, low-sodium, low-saturated fat, low-cholesterol, and high-fiber content. A diet that includes 5 or more servings of fresh fruits and vegetables a day may also help reduce the risk of stroke.

  • Maintain a healthy weight.

  • Stay physically active. It is recommended that you get at least 30 minutes of activity on most or all days.

  • Do not smoke.

  • Limit alcohol use to:

  • No more than 2 drinks per day for men.

  • No more than 1 drink per day for nonpregnant women.

  • Do not use illegal drugs.

  • Keep all follow-up appointments as directed by your caregiver.

SEEK IMMEDIATE MEDICAL CARE IF:

You develop TIA or stroke symptoms. Time is of the essence. It is important to seek treatment within 3 to 4 hours from the start of stroke symptoms. Thrombolysis or "clot dissolving" medicine given within this time frame can help dissolve the clot in your brain and save your life. Even if you do not know when your symptoms began, get treatment as soon as possible. This is a medical emergency. Call your local emergency services (911 in U.S.). Do not drive yourself to the clinic or hospital.