|Carotid Artery Disease: A Cause of Stroke and Transient Ischemic Attacks (TIAs) |
What is carotid artery disease?
when the major
arteries in your
neck (called the
or blocked. These
from your heart
to your head, and
should be smooth
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
- 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.