CAROTID ARTERY DISEASE

The carotid arteries are two large blood vessels in your neck. They supply your brain with blood. Carotid artery disease develops when the arteries become narrow, usually because of atherosclerosis, the buildup of cholesterol and other material in an artery. If a blood clot sticks in the narrowed arteries, blood can’t reach your brain. This is one of the causes of stroke.

Factors that increase your risk of carotid artery disease include:

  • High blood pressure
  • Smoking
  • Diabetes
  • High blood-fat levels
  • Family history
  • Age
  • Obesity
  • Sleep apnea
  • Lack of exercise

Carotid artery disease develops slowly. In its early stages, carotid artery disease often does not have any signs or symptoms. The condition may go unnoticed until it is serious enough to deprive your brain of blood, causing a stroke or transient ischemic attack (TIA), a temporary shortage of blood flow to your brain.

Signs and symptoms of a stroke or TIA include:

  • Sudden numbness or weakness in the face or limbs, often on only one side of the body
  • Sudden trouble speaking and understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden dizziness or loss of balance
  • Sudden, severe headache with no known cause

DIAGNOSIS

Your doctor will perform a physical examination, ask about your symptoms and discuss your medical history. He will suggest one or more diagnostic tests. These include:

  • Ultrasound uses sound waves to produce pictures of internal organs. It can be used to assess blood flow and pressure in the carotid arteries.
  • Computerized tomography (CT) scan combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of internal organs. It can be used to look for evidence of stroke or other abnormalities.
  • Magnetic resonance imaging (MRI) uses a magnetic field and pulses of radio wave energy to create detailed images of internal organs. It can be used to look for evidence of stroke or other abnormalities.
  • CT angiography or MR angiography provides additional images of blood flow in the carotid arteries. A contrast dye is injected into a blood vessel, and a CT scan or MRI gathers images of your neck and brain.

 

TREATMENT

Treatment of carotid artery disease usually involves a combination of lifestyle changes, medication and sometimes surgery. The goal in treating carotid artery disease is to prevent stroke. Specific treatments depend on the extent of blockage in your carotid arteries.

If blockage is mild to moderate, your doctor may recommend:

1. Lifestyle changes to slow the progression of atherosclerosis. Recommendations may include:

  • Don’t smoke.
  • Maintain a healthy weight.
  • Limit cholesterol and fat.
  • Eat a variety of fruits and vegetables.
  • Limit salt.
  • Exercise regularly.
  • Limit alcohol.
  • Control chronic conditions. Managing conditions such as diabetes and high blood pressure helps protect your arteries.

2. Medication to control blood pressure or lower cholesterol. Your doctor may also recommend taking a daily aspirin or other blood-thinning medication to prevent blood clots.

If blockage is severe, or if you’ve already had a TIA or stroke, your doctor may recommend removing the blockage from the artery. The options include:

  • Carotid endarterectomy, the most common treatment for severe carotid artery disease. After making an incision along the front of your neck, the surgeon opens the affected carotid artery and removes the plaques. The artery is repaired with either stitches or a graft.
  • Carotid angioplasty and stenting, if the blockage is too difficult to reach with carotid endarterectomy or you have other health conditions that make surgery too risky. You are given local anesthesia and a tiny balloon is threaded by catheter to the area of the clog. The balloon is inflated to widen the artery, and a small wire mesh coil (stent) is inserted to keep the artery from narrowing again.

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