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Written by Ruai Pharmaceuticals   
Monday, 22 August 2011 18:50

Carotid Artery Disease: Causes, Symptoms, Tests, and Treatment

Carotid artery disease introduction
  • How does carotid artery disease happen?
  • What are the risk factors for carotid artery disease?
  • What are the symptoms of carotid artery disease?
  • What is a transient ischemic attack (TIA)?
  • How is carotid artery disease diagnosed
  • What's the treatment for carotid artery disease?
  • What are the recommended lifestyle changes for carotid artery disease?
  • Which drugs can reduce the risk of stroke?
  • What medical procedures treat carotid artery disease
  • Find a local Cardiologist in your town

Carotid Artery Disease Introduction

Carotid artery disease is also called carotid artery stenosis. The term refers to the narrowing of the carotid arteries. This narrowing is usually caused by the buildup of fatty substances and cholesterol deposits, called plaque. Carotid artery occlusion refers to complete blockage of the artery. When the carotid arteries are obstructed, you are at an increased risk for a stroke, the third leading cause of death in the U.S.

How Does Carotid Artery Disease Happen?

Like the arteries that supply blood to the heart -- the coronary arteries -- the carotid arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessels.

Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke.

A stroke -- sometimes called a “brain attack” -- is similar to a heart attack. It occurs when blood flow is cut off from part of the brain. If the lack of blood flow lasts for more than 3 to 6 hours, the damage is usually permanent. A stroke can occur if:

  • the artery becomes extremely narrowed
  • there's a rupture in an artery to the brain that has atherosclerosis
  • a piece of plaque breaks off and travels to the smaller arteries of the brain
  • a blood clot forms and obstructs a blood vessel

Strokes can occur as a result of other conditions besides carotid artery disease. For example, sudden bleeding in the brain, called intracerebral hemorrhage, can cause a stroke. Other possible causes include:

  • sudden bleeding in the spinal fluid space -- subarachnoid hemorrhage
  • atrial fibrillation
  • cardiomyopathy
  • blockage of tiny arteries inside the brain

What Are the Risk Factors for Carotid Artery Disease?

The risk factors for carotid artery disease are similar to those for other types of heart disease. They include:

  • age
  • smoking
  • hypertension (high blood pressure) -- the most important treatable risk factor for stroke
  • abnormal lipids or high cholesterol
  • diet high in saturated fats
  • insulin resistance
  • diabetes
  • obesity
  • sedentary lifestyle
  • family history of atherosclerosis, either coronary artery disease or carotid artery disease

Men under the age of 75 have a greater risk than women. Women have a greater risk over the age of 75. People who have coronary artery disease have an increased risk of developing carotid artery disease. Typically, the carotid arteries become diseased a few years later than the coronary arteries.

What Are the Symptoms of Carotid Artery Disease

You may not have any symptoms of carotid artery disease. Plaque builds up in the carotid arteries over time with no warning signs until you have a transient ischemic attack (TIA) or a stroke.

Signs of a stroke may include:

  • sudden loss of vision, blurred vision, or difficulty in seeing out of one or both eyes
  • weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg
  • sudden difficulty in walking, loss of balance, lack of coordination
  • sudden dizziness and/or confusion
  • difficulty speaking (called aphasia)
  • confusion
  • sudden severe headache
  • problems with memory
  • difficulty swallowing (called dysphagia)

What Is a Transient Ischemic Attack (TIA)?

A TIA occurs when there is a low flow of blood or a clot briefly blocks an artery that supplies blood to the brain. With a TIA, you may have the same above symptoms as you would have for a stroke. But the symptoms only last a few minutes or few hours and then resolve.

A TIA is a medical emergency because it is impossible to predict whether it will progress into a major stroke. If you or someone you know experiences any of the above symptoms, get emergency help. Immediate treatment can save your life and increase your chance of a full recovery.

Findings show that someone who has experienced a TIA is 10 times more likely to suffer a major stroke than a person who has not had a TIA.

How Is Carotid Artery Disease Diagnosed?

There are often no symptoms of carotid artery disease until you have a TIA or stroke. That's why it's important to see your doctor regularly for physical examinations. Your doctor may listen to the arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard over an artery or vascular channel, it may reflect turbulent blood flow. That could indicate carotid artery disease.

Listening for a bruit in the neck is a simple, safe, and inexpensive way to screen for stenosis (narrowing) of the carotid artery. As a screening test, though, it's inexact. Some experts believe that bruits may be better predictors of atherosclerotic disease rather than risk of stroke. Be sure to let your doctor know if you have had any symptoms, such as those listed above.

Your doctor may also use a test to diagnose carotid artery disease. Possible tests include the following:

  • Carotid ultrasound (standard or Doppler). This noninvasive, painless screening test uses high-frequency sound waves to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked. A Doppler ultrasound shows the movement of blood through the blood vessels. Ultrasound imaging does not use ionizing radiation (X-rays).
  • Magnetic resonance angiography (MRA). This newer imaging technique uses radio waves and a powerful magnet to gather accurate information about the brain and arteries. Then a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain.
  • Computerized tomography angiography (CTA). More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross sectional images of the carotid arteries. Images of the brain can be collected as well. With this imaging test, the scan may reveal areas of damage on the brain. The CT scan uses a low level of radiation.
  • Cerebral angiography (carotid angiogram). This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. The procedure provides the best information. It does carry a small risk of serious complications.

What's The Treatment For Carotid Artery Disease

To effectively treat carotid artery disease, doctors recommend the following:

  • following recommended lifestyle habits
  • taking medications as prescribed
  • considering a procedure to improve blood flow, if your doctor believes it could help

What Are the Recommended Lifestyle Changes for Carotid Artery Disease?

To keep carotid artery disease from progressing, the following lifestyle changes are recommended:

  • Quit smoking.
  • Control high blood pressure (optimal blood pressure is 120/80 mmHg).
  • Control diabetes.
  • Have regular check-ups with your doctor.
  • Have your doctor check your cholesterol and get treatment, if necessary.
  • Eat foods low in saturated fats, trans fats, cholesterol, and salt.
  • Eat only enough calories to maintain a healthy weight; avoid weight gain.
  • Increase exercise to at least 30 minutes of physical activity most days of the week.
  • Limit alcohol to one drink per day for women, two for men.

Which Drugs Can Reduce the Risk of Stroke?

Your doctor may recommend antiplatelet medications such as aspirin and clopidogrel (Plavix) to decrease the risk of stroke due to blood clots. Your doctor may also prescribe medications to lower cholesterol and/or antihypertensives to lower your blood pressure. In some cases, Coumadin (warfarin), a blood thinner, may be prescribed.

What Medical Procedures Treat Carotid Artery Disease?

If there is severe narrowing or blockage in the carotid artery, a procedure can be done to open the artery. This will increase blood flow to the brain to prevent future stroke. Your doctor may suggest either of the following procedures:

  • Carotid endarterectomy (CEA). This has been the commonly performed procedure for patients who have carotid atherosclerosis and TIAs or mild strokes. While you're under general anesthesia, an incision is made in the neck at the location of the blockage. The surgeon isolates the artery and surgically removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow improved blood flow to the brain. The risks and benefits of CEA depend on your age, the degree of blockage, and whether you've had a stroke or TIA.
  • Carotid artery stenting (CAS). Carotid artery stenting (CAS) is a newer treatment option. It's less invasive than carotid endarterectomy and is performed in a catheterization laboratory. With CAS, a small puncture is made in the groin. A specially designed catheter is threaded to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to open the artery. Then, a stent is placed in the artery and expanded to hold the artery open. A stent is a small stainless steel mesh tube that acts as a scaffold to provide support inside your artery. The stent stays in place permanently. CAS is still a new procedure and there is significant controversy as to how well it prevents strokes caused by carotid artery disease.


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Last Updated on Sunday, 11 December 2011 13:44
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