Carotid Artery Disease

Basic Facts

  • Carotid arteries are two blood vessels on either side of the neck that carry blood to the head and brain.
  • Carotid artery disease is a buildup of plaque in these arteries, which can narrow the space through which blood flows.
  • Carotid artery disease is a type of peripheral arterial disease, which is blockage of the arteries that carry blood from the heart to the limbs, head and organs.

 

Many people with carotid artery disease have no symptoms. However, it is a major cause of stroke or TIA, which occurs if the blood flow to the brain is interrupted or cut off. Symptoms then depend on which portion of the brain was affected. 

The classic symptoms of stroke or TIA because of carotid artery disease are:

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

If these warning symptoms clear up on their own within minutes of onset, leaving no residual effects, it may be a TIA (transient ischemic attack), also called "mini- stroke". If these symptoms last longer than a few hours, it could be a stroke.

These symptoms should always be considered potentially serious and should be promptly evaluated, as emergency care may be needed. 

Atherosclerosis is the cause of carotid artery disease, which is due to both cholesterol and inflammation. It is caused by plaque that gradually builds up in arteries over time, causing them to narrow, and reducing blood flow. Plaque is composed of a variety of substances, including cholesterol, calcium, and inflamed cells. When plaque ruptures, it releases these substances into the bloodstream, which leads to the formation of a blood clot inside the artery. If the carotid artery, this can result in a stroke.  

Risk increases with age:  <1% of adults in their 50s have significant narrowing of their carotid arteries. But 10% of adults in their 80s have extensive narrowing. 

Patients are at increased risk for developing carotid artery disease and stroke if they already have coronary artery disease or have a family history of cardiovascular disease or stroke.  

Other factors that increase a person’s risk include: 

  • Smoking 

  • Hyperlipidemia or lipid disorders - High levels of cholesterol in the blood can increase the risk of plaque buildup

  • Hypertension (high blood pressure) - uncontrolled high blood pressure can result in hardening and thickening of the arteries

  • Diabetes  

  • Male gender 

  • Advanced age 

  • Obesity and lack of exercise 

  • Alcohol and drug abuse 

  • To diagnose Carotid Artery Disease, your healthcare provider may hear a “bruit” on your neck with their stethoscope. A “bruit” is the name for the “whooshing” sound caused by turbulent blood flow in a narrowed artery.  

  • Blood pressure measurement in both arms to detect possible narrowing in other branches of the blood vessels of the upper body. 

  • Carotid Duplex Ultrasound - painless, noninvasive test where soundwaves are used to create pictures of the inside of the carotid arteries and allows doctors to measure the speed of blood flow through them. These are done in our offices.  

  • Arteriogram – Also called angiogram, contrast material, or “dye”, is injected into an artery, then pictures are taken (MRI, CT scan, or x-ray). This produces detailed images that can show narrowing or blockages. These are done outside of our offices at a radiology facility and/or hospital.  

How carotid artery disease is treated depends on the patient’s symptoms, the status of all blood vessels supplying blood flow to the brain, and the degree of narrowing in the carotid artery. 

Medication such as aspirin or other antiplatelet medicines can help prevent obstruction of the carotid arteries, as well as cholesterol-modifying medications or lipid therapy, which helps lower the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol. 

Sometimes more aggressive treatment is needed to restore and improve blood flow to the brain. These option might include: 

  • Angioplasty and Stenting - During this non-surgical procedure, a balloon attached to a small catheter is inflated within an artery to flatten the plaque against the artery wall, increasing the artery's diameter. In most cases, a stent, a metal-mesh tube, is expanded and left inside the artery to support the expansion and maintain blood flow.
  • Carotid Endarterectomy – With this surgical procedure, plaque is removed from the inner lining of the carotid arteries. 

As with many cardiovascular conditions, lifestyle factors can contribute to carotid artery disease. The first step a patient should take is to modify any behavior that increases the risk for carotid artery disease. Some of these changes should include:
  • Quitting smoking,
  • Controlling high blood pressure,
  • Lowering cholesterol,
  • Exercising,
  • Losing weight,
  • Controlling diabetes, and 
  • Reducing alcohol intake.