To work efficiently, the brain needs a constant supply of oxygen and nutrient-rich blood. A significant portion of the blood flow to your brain comes from the carotid arteries. Both the left and right internal carotid arteries supply blood to the major areas of the brain responsible for everyday activities, including speaking, thinking and walking.
Atherosclerosis is caused by a buildup of fatty substances like cholesterol called “plaque” which results in a thickening and hardening of the vessel resulting in decreased blood flow to the brain tissues.
Risk Factors You Cannot Change
Certain factors can increase your risk of atherosclerosis and carotid artery disease. Some of these risk factors cannot be modified or changed such as:
- Increasing age
- Family history of stroke
Risk Factors You Can Control
Risk factors which you can control include:
- High blood pressure
- Elevated cholesterol
Symptoms of Carotid Artery Disease
Most individuals have no symptoms of carotid artery disease. Others may experience the symptoms of a TIA (temporary stroke or mini stroke), or stroke. A stroke or “brain attack” is an injury to the brain caused by lack of oxygen. This occurs in about 700,000 people a year in the United States. About 280,000 patients die each year from stroke-related causes. Transient ischemic attacks (TIAs) are warning signs that you are at high risk for experiencing a stroke. If you have any of the warning signs of a stroke or TIA, it may be a sign of blockage in the carotid arteries. These may include but are not limited to:
- Sudden numbness or weakness of the face, arm or leg, especially on one side
- Sudden trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden trouble walking, loss of balance or coordination
Tests Which Aid in the Diagnosis of Carotid Artery Disease
Carotid Duplex or Ultrasound. This noninvasive screening test involves imaging your neck with a sound wave probe. This is done in our office by a licensed vascular technician taking approximately 30 minutes.
Angiogram. A catheter (small hollow tube) is used to inject contrast (dye) into the carotid arteries. This invasive test is performed by your document at the cardiac catheterization labs.
Computerized Axial Tomography Scan (CT or CAT Scan). This uses x-rays to create three-dimensional images of the carotid arteries or brain. It can be done with contrast (x-ray dye) if your doctor wants to see the blood vessels.
Magnetic Resonance Angiogram/Imaging (MRA/MRI). An MRA uses a very strong magnet to make three-dimensional images the carotid arteries or brain. An MRA can show atherosclerosis of the carotid arteries, or areas of the brain damaged by a previous stroke. This can be done with or without contrast or dye.
Treatment Options for Carotid Artery Disease
Treatment options for atherosclerotic carotid artery disease include:
- Medication - aspirin, statins, antiplatelet therapy, diet
- Surgery - endarterectomy with or without patch angioplasty
- Carotid Artery Stenting - placing a Nitinol self-expanding mesh across the blockage
Using stents in the treatment of carotid artery disease offers a nonsurgical option for patients which we believe offers excellent outcomes with lower risks than surgery.
Carotid endarterectomy (CEA) is a surgical procedure that removes the blockage from the affected carotid artery. An incision is made in your neck into the artery where the plaque is, a patch is sewed in place and then the artery is closed with stitches. The procedure is usually done under general anesthesia. CEA is one of the most common surgical procedures in the United States having been performed for over 50 years.
Carotid Artery Stenting
Carotid artery stenting is an endovascular treatment which means that it is done in a special catheterization laboratory without general anesthesia or surgical incisions. Clinical studies have shown that carotid stenting is as safe and as effective as CEA with less risk. The procedure uses a stent (small latticed metal tube) to open partially blocked arteries and to hold the plaque against the artery wall.
The stent is made from nickel-titanium or a stainless steel alloy, a metal that is bendable but springs back into its original shape after being bent. An embolic protection device (EPD) is also used to help catch any pieces of plaque or other particles that may be released during the procedure.
The stent is introduced into the narrowed blood vessel on a catheter, after an embolic protection device has been temporarily placed beyond the narrowed area of the artery. The stent is released and stays in place permanently, holding the artery open and improving blood flow. All of the devices, except the stent, are taken out your body at the end of the procedure.
In some cases the protection system inserted does not have a distal filter as shown but rather is inserted below the blockage and prevents any debris from traveling up into the brain. This “proximal protection “system will be used at your doctor's discretion if he believes this will result in a safer procedure for you. In the end the idea is to provide a safe environment for the treatment of the blockage with excellent long-term results. For more information see Carotid Artery Stent Procedure.