Carotid Artery Disease
Carotid artery disease (or carotid artery stenosis) occurs when the major arteries in your neck, which deliver oxygen-rich blood to your brain, become narrowed and potentially blocked by the buildup of plaque (atherosclerosis). The carotid arteries, located on either side of your neck, run from your aorta (in your chest) to your brain. Carotid artery disease is a form of peripheral artery disease.
Carotid Artery Disease Symptoms and Diagnosis
As plaque builds and the carotid arteries continue to narrow, the amount of blood the brain receives is reduced. The blockage of blood flow to the brain can result in a stroke.
Most strokes related to carotid artery disease occur when pieces of plaque or blood clots break away from artery walls and travel into the brain, where they can block one of the brain's smaller arteries.
Strokes can also occur if blood clots form in the carotid arteries and totally block blood flow. This can happen if plaque in an artery bursts; such clots can also block the arteries.
Carotid artery disease may not cause any signs or symptoms until the arteries are badly blocked. As a result, for some people, the first sign of the disease may be a stroke.
Warning signs of a stroke include transient ischemic attack (TIA) or "mini-stroke":
- Sudden weakness or numbness on one side of the face, or in one arm or leg
- Inability to control the movement of an arm or leg
- Loss of vision or blurred vision in one or both eyes
- Inability to speak clearly
- Dizziness or confusion
A TIA occurs as a result of temporary reduction in the blood flow to the brain. Symptoms of a TIA typically may last for only a few minutes but can be present for as long as 24 hours.
If you experience symptoms of a TIA, call 911 immediately. If such symptoms persist after 24 hours, you have probably suffered a stroke. Even if a TIA does not progress into a major stroke, it is a strong predictor of future stroke: someone who experiences a TIA is 10 times more likely to suffer a major stroke.
- High cholesterol
- High blood pressure
- Older age
- Insulin resistance
- Metabolic syndrome: Includes high blood pressure, high triglycerides, elevated insulin levels and excess body fat around the waist.
- Family history of atherosclerosis
Since you may not have any symptoms of carotid artery disease, it is important to have regular check-ups if you have risk factors. Carotid artery disease can be diagnosed based on your medical history and the results of an exam and tests, including:
- Carotid duplex ultrasound, the most common imaging tests to diagnose carotid artery disease
- CT scan and CT angiography (CTA)
- Magnetic resonance angiography (MRA)
- Carotid angiography
Carotid Artery Disease Treatment at BIDMC
Your treatment for carotid artery disease will depend on:
- The severity of your condition
- Whether you are having symptoms
- Your general health
Changing your lifestyle may keep your carotid artery disease from progressing. For some people, such changes are all that is needed in terms of treatment:
- Quitting smoking
- Exercising regularly (check with your doctor before beginning an exercise program)
- Losing weight if you are overweight
- Eating a healthy diet aimed to lower your blood pressure and cholesterol
If lifestyle changes aren’t enough to control your carotid artery disease, you may need medications to treat high blood pressure or high cholesterol, or to prevent blood clots.
Surgery is typically performed if your carotid arteries are at least 50 percent blocked, or blocked more than 80 percent and you are not having symptoms.
- Open carotid endarectomy surgery removes the plaque that is blocking your artery.
- Endovascular carotid angioplasty and stenting, a minimally invasive procedure, uses a catheter to flatten plaque against your artery walls and insert a stent to keep the artery open.