Spring 2008
Carotid Artery Disease: A Cause of Stroke and Transient Ischemic Attacks (TIAs)

What is carotid artery disease?
Carotid artery disease develops when the major arteries in your neck (called the carotid arteries), become narrowed or blocked. These arteries extend from your heart to your head, and supply oxygenrich blood to your brain.

Ideally, arteries should be smooth and unobstructed on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of calcium, cholesterol and fibrous tissue. Over time, more plaque builds up, and the arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Hardened arteries slow the blood flow to your brain. When the brain cells do not get enough oxygen, they may die, resulting in a stroke.

The older you are, the more likely you are to develop carotid artery disease. Only 1 percent of adults age 50 to 59 have significantly narrowed carotid arteries, compared to 10 percent of adults age 80 to 89.

What are the symptoms of carotid artery disease?
Unfortunately, the first sign of carotid artery disease could be a stroke. Many people with carotid artery disease experience warning symptoms of a stroke called a transient ischemic attack (TIA). Spelling the word FAST will help you remember the symptoms of both TIA and stroke, and what to do in an emergency situation, should symptoms occur:

How is carotid artery disease diagnosed?
In its early stages, your physician may discover you have the disease during a routine history and physical exam, which may include listening to your neck for a bruit. A bruit is a sound made when blood moves through narrowed vessels, and can indicate carotid artery problems.

If the physician suspects you have carotid artery disease, he or she will request a carotid duplex ultrasound. During this test, a small probe is pressed against your neck. The probe emits high-frequency sound waves that bounce off of blood cells and blood vessel walls creating an image, showing if there are blood flow problems due to a narrowed carotid artery.

This test detects most cases of carotid artery disease. If the ultrasound does not provide enough information, you may be sent to have one or more of the following: CAT Scan Angiography (CTA), Magnetic Resonance Angiography (MRA) or Digital Angiography.

Symptomatic carotid artery disease results in the symptoms of stroke and TIA. If you are sent to the Emergency Department because you are experiencing any of the TIA or stroke symptoms (F-A-S-T), the Emergency Department physician will perform a history and physical exam and order any tests that will help diagnosis your carotid artery disease.

How is carotid artery disease treated?
Treatment is individualized. As a first step, your physician may recommend medications and lifestyle changes. Other options may include

  • Surgery: If you have stroke symptoms and moderate to severe carotid artery stenosis (narrowing), you may be considered for surgery. During surgery, your vascular surgeon opens the artery and removes the plaque from the artery wall. The procedure is called a carotid enderarterectomy. With the plaque gone, the inner lining of the artery is smooth and open, allowing blood to flow freely through the artery and to your brain. This procedure is safe and long-lasting when performed by a qualified vascular surgeon in the proper setting.
  • Stenting: A less-invasive treatment for carotid artery disease is carotid artery stenting (CAS). A long, thin tube called a catheter is inserted into a groin artery and is guided up through your blood vessels to your blocked carotid artery. The catheter carries a tiny balloon that inflates and deflates, flattening the plaque against the walls of the artery. An expandable metal stent is then placed inside the artery to keep the walls open. To protect the brain, a tiny mesh umbrella is placed just beyond the blockage to catch any debris that might be released during the procedure. Stenting is currently controversial because conclusive, long-term results are not yet available. Right now, CAS seems to be most beneficial for patients who are not good candidates for surgery. Talk to your doctor to find out if this procedure is right for you.

What can I do to stay healthy?

  • Learn and understand the warning signs of TIA and stroke (F-A-S-T).
  • Keep to your physician’s instructions for any prescribed medications or follow-up testing because the carotid blockage may worsen over time, even without warning signs or symptoms.
  • Quit smoking. This is the most important change you can make to avoid this disease. Quitting smoking can lower your blood pressure and help make your arteries healthier.
  • Control other health conditions such as diabetes, high blood pressure (hypertension) or high blood cholesterol.
  • Exercise regularly. The American Heart Association generally recommends a minimum of 30 minutes of exercise on most days of the week.
  • Maintain a healthy weight. Try to reach a healthy weight and stay there. Losing just 5 to 10 percent of your body weight can help lower your risk of developing carotid artery disease.