Carotid Artery Disease

Basic Facts

  • Carotid Artery Disease (CAD) is the narrowing or blockage of the arteries in the neck that supply oxygen-rich blood to the brain. This condition is a common problem, and a major cause of stroke.
  • Most patients who have a stroke from CAD do not have warning symptoms before the stroke occurs.
  • When a patient is found to have significant CAD before stroke occurs, the stroke can usually be prevented by appropriate treatment.
  • Patients are at increased risk for developing carotid artery disease and stroke if they already have coronary artery arteriosclerotic heart disease, or have a family history of heart disease or stroke.
  • CAD is caused by the same factors that contribute to coronary artery arteriosclerotic heart disease, but it tends to develop later in life.
  • Fewer than one percent of adults in their fifties have significant narrowing of their carotid arteries, but 10 percent of adults in their eighties have extensive narrowing.
  • Atherosclerosis (hardening of the arteries) cannot be prevented altogether, but progression of the disease can be slowed and the risk of developing atherosclerosis can be reduced through changes in lifestyle and diet. The best preventive measures are exercising regularly, eating a diet low in cholesterol and saturated fat, and maintaining a healthy weight. A class of drugs called statins can also reduce the amount of cholesterol in the bloodstream, and may limit the growth of plaque.

Symptoms

Many people with CAD have no symptoms. A warning sign called, transient ischemic attack (TIA) will sometimes appear before a stroke occurs; however, this is not always the case with patients who suffer from a stroke resulting from CAD. Warning symptoms depend primarily on whether the plaque surface has become soft or cracked. Unfortunately, a stroke is frequently the first symptom of carotid arteriosclerosis.

The classic symptoms of TIA that are caused as a result of CAD, include:

  • Partial loss of vision in one eye
  • Weakness, tingling, or numbness (that comes on without apparent cause) on one side of the body or in one arm or leg
  • Temporary loss of movement control in one arm or leg
  • Inability to pronounce words or speak clearly

These warning symptoms typically go away on their own within minutes of the onset (leaving no residual effects), and can pop up unexpectedly and repeatedly. These signs should always be regarded as potentially serious, and should be promptly reported to a doctor. These are also symptoms indicative of a stroke when they last for longer than a few hours.

Causes & Risk Factors

Atherosclerosis is the cause of CAD. With age, fatty deposits (called plaque) build up inside the walls of the arteries, causing them to narrow. This progressive disease process occurs in varying degrees throughout many of the body’s major arteries. Atherosclerosis is at the root of most arterial disease, including carotid artery disease. Factors that increase a person’s risk for carotid artery disease include:

  • Smoking
  • High blood pressure
  • Diabetes
  • Family history of atherosclerosis

Additionally, men are at higher risk for CAD than women.

Diagnosis

To diagnose CAD, a physician will first obtain a detailed description of a patient’s symptoms. The physician may use a stethoscope to listen to the carotid arteries on both sides of the neck to detect a “bruit” or “whooshing” sound caused by turbulent blood flow through a narrowed carotid artery. Blood pressure measurement for both arms is another important part of evaluating carotid artery disease, in order to detect possible narrowing in other branches of the blood vessels of the upper body. Depending on the results of the patient’s history and findings from the physical exam, the physician may order any of the following tests:

  • Carotid Duplex Ultrasound
  • Transcranial Doppler Ultrasound
  • Computed Tomography (CT) Scan
  • Magnetic Resonance Angiography (MRA)
  • Arteriography

Treatment Options

Treatment for CAD is dependent upon the patient’s symptoms, the status of all the blood vessels supplying blood to the brain, and the degree of narrowing in the carotid artery. Not all cases of CAD require a surgical or interventional procedure to treat them.

If the patient has been referred to a vascular specialist, chances are there is extensive narrowing (or, stenosis) of the carotid arteries. The disease is usually treated if there is evidence of a TIA and a significant lesion in the artery. Sometimes patients with a history of prior stroke, who remain at risk for further stroke, are also treated. If the level of severity does not require direct treatment, lifestyle changes and medication can be used to try to limit the growth of plaque. Another important part of non-operative treatment is to ensure that the patient and immediate family members understand the warning signs of TIA and remain observant.

More invasive treatment methods include:

  • Carotid Endarterectomy—Carotid endarterectomy is a surgical procedure and the most commonly used, traditional, and most favored approach for removing plaque from the inner lining of the carotid arteries. During this procedure, a surgeon exposes the carotid artery through an incision in the neck. Sometimes a small tube is inserted into the normal segment of carotid artery below and above the narrowed segment, bypassing the blood around the part of the carotid artery to be cleaned out. In other cases, the collateral blood flow from other arteries is sufficient enough that a shunt is not needed. The carotid artery is then opened, and the lining and the plaque it contains is carefully and precisely removed to leave a smooth, wide-open artery. Afterward, the artery is stitched shut, and the shunt (bypass) tube (if used) is removed. Recovery is rapid, and the patient may be able to leave the hospital the day after the procedure.
  • Angioplasty and Stenting—Angioplasty and stenting are minimally-invasive techniques performed using local anesthesia. Angioplasty involves threading a balloon-tipped catheter through an artery in the groin, and up into the narrowed area of the carotid artery. Inflating the balloon expands the artery, effectively opening it. Physicians also insert a stent (a tiny metal mesh tube that serves as scaffolding) to hold the artery open, in almost every carotid-related angioplasty / stenting procedure.

Preventive Lifestyle Changes

With CAD, and many other cardiovascular conditions, lifestyle factors often contribute. The first step a patient can take is to modify any behavior(s) that increases the risk for CAD. These changes should include:

  • Quitting smoking
  • Losing weight
  • Exercising regularly
  • Reducing cholesterol and saturated fat intake
  • Reducing alcohol intake

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Medical Review Date: March 5, 2005 / Copyright © 2012 NorthPoint Domain, Inc. All rights reserved. This material cannot be reproduced in digital or printed form without the express consent of NorthPoint Domain, Inc. Unauthorized copying or distribution of NorthPoint Domain’s Content is an infringement of the copyright holder’s rights.

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