Carotid Disease Overview

Carotid artery disease occurs when fatty deposits (plaques) clog the blood vessels that deliver blood to your brain and head (carotid arteries). The blockage increases your risk of stroke, a medical emergency that occurs when the blood supply to the brain is interrupted or seriously reduced.  Carotid narrowing can occur gradually over a period of time and can progress to Severe Blockages in People that have certain risk factors:

• Hypertension or High Blood Pressure
• Diabetes
• High Cholesterol
• Family History of Stroke or Heart Disease 
• Personal Health Habits such as Smoking, Diet, and Obesity

In addition, in some People, an injury to the Blood Vessel may result in a small “tear” that can cause the linings of the Vessel Wall to separate causing a sudden narrowing or “Dissection”. 

Both of this conditions can result in symptoms of a Stroke.  A Stroke deprives your brain of oxygen. Within minutes, brain cells begin to die. Stroke is the 5th most common cause of death and the leading cause of permanent disability in the U.S.

Carotid artery disease develops slowly. The first sign that you have the condition may be a stroke or transient ischemic attack (TIA). A TIA is a temporary shortage of blood flow to your brain.

Symptoms

In its early stages, carotid artery disease often doesn’t produce any signs or symptoms. The condition may go unnoticed until it’s serious enough to deprive your brain of blood, causing a stroke or TIA.

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

Treatment

Treatment of carotid artery disease usually involves a combination of lifestyle changes, medication and sometimes surgery.  

•  Medications and Lifestyle Modifications

  • Smoking Cessation
  • Cholesterol Lowering Medication
  • Blood Pressure Management
  • Diabetes Control
  • Diet and Exercise
  • Blood Thinners such as Aspirin, Plavix, and Others

• Surgery

  • Several different options for Surgery may be available, including a traditional operation where an incision is made in the neck, the carotid artery is opened, and the “Plaque” is surgically removed.  This operation is called a “Carotid Endarterectomy” and can be performed in many patients that have disease in an accessible location and do not have too many high risk factors – such as severe Heart disease, poor collateral circulation, multiple or bilateral disease (both sides).

• Carotid Artery Angioplasty and Stenting

  • In many Patients, a less Invasive option of threading a “tube” or Catheter from the Artery in the Leg or Arm can be performed, and a Balloon can be inflated to “Stretch” the Plaque and Open the Blood Vessels.  A special metallic scaffold called a “Stent” can then be placed to keep the artery widely “Open” similar to traditional surgical operations.
  • This type of Procedure has gained in popularity and utilization as techniques have improved and experience has grown within the community.
    • Can be performed without General Anesthesia
    • Can be performed in locations that are not accessible by Surgery
    • May be Safer in Patients that have High-Risk situations such as severe Heart and Lung Disease, History or Radiation Therapy, Multiple narrowings on Both Sides of the Neck or also within the Brain

Intracranial Atherosclerotic Disease and MoyaMoya

Plaque buildup can also occur within the smaller arteries further up in the Brain and cause similar Symptoms and Syndromes such as TIA’s and Strokes.  In addition, Dissections or “Tears” in the Blood vessels may also result in Narrowing of the Cerebral Vessels as well as certain Inflammatory Conditions such as Auto-immune diseases or infections.  In most cases, medications are prescribed and risk-factors described above are managed.  However, in certain situations, a Person may be very high risk for suffering a serious disabling or life-threatening stroke, and an Operation may be considered.  Most commonly, operations that may be considered included Angioplasty and Stenting, but sometimes an Open Brain Surgery to create a Bypass is recommended depending on the type of Disease a Person possesses.