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Carotid Artery Disease

Your arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain.

Severe narrowing of the carotid arteries can lead to stroke and death. Like the arteries that supply blood to the heart, the carotid arteries can also develop atherosclerosis which is the build-up of fat and cholesterol deposits, called plaque, on the inside of the vessels.

Over time, the plaque narrows the artery, decreases blood flow to the brain and can lead to a stroke. You can feel your carotid arteries by feeling the pulse on your lower neck, on either side of your windpipe. The carotid arteries supply blood to the large, front part of the brain, which is responsible for our personality and our ability to think, speak and move. 

Diagnosis

Fortunately, the diagnosis of carotid artery narrowing can usually be done painlessly with an ultrasound. Your physician may hear an abnormal sound when they are listening to your neck with a stethoscope. This is called a bruit (pronounced brew-ee).

If you've had an episode where you briefly lose vision in one eye, had weakness on one side of your body, had slurred speech or weren’t able to get your words out, your doctor will likely order an ultrasound.

Risk Factors

Your physician may also order an ultrasound if you have risk factors for stroke:

  • Tobacco smoking
  • Heart disease
  • Hypertension
  • Aneurysm
  • Prior vascular bypass

Treatment

Carotid artery disease is treated by:

  • Lifestyle modification
  • Medications
  • Procedures

Lifestyle Modification

To prevent further progression of disease, lifestyle modification is recommended to limit all risk factors for coronary and carotid artery disease. Modifications include:

  • Stopping smoking
  • Getting regular exercise
  • Controlling blood pressure and diabetes
  • Treating elevated cholesterol
  • Maintaining normal weight
  • Getting regular check-ups with your doctor

Medications

All people with carotid disease should be on aspirin to decrease the risk of stroke due to blood clots. In some cases, Coumadin may be prescribed. If so, blood work needs to be checked regularly to ensure the proper dose.

Procedures

If the carotid artery has severe narrowing or blockage, a procedure must be done to open the artery and allow blood flow to the brain, to prevent suture stroke:

  • Carotid stenting:  Performed in a catheterization laboratory, a small puncture is made in the groin. A specially designed catheter with an umbrella tip is placed over a guide wire and directed to the area of narrowing in the carotid artery. Once in place, a small stainless steel mesh tube that acts as a scaffold to provide support inside balloon tip is inflated for a few seconds to dilate the artery. Then, a stent (a stainless steel mesh tube) is placed in the artery and opens to fit the size of the artery. Tiny filters are used to capture any particles that are released, to prevent these particles form going to the brain and causing a stroke.  The stent stay in place permanently.
  • Carotid endarterectomy: This is the standard surgical treatment for carotid artery disease. An incision is made in the neck, at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and diseased portions of the artery. The artery is sewn back together to allow blood flow to the brain.