Carotid Artery Disease: Symptoms, Diagnosis and Treatment

Carotid Artery DiseaseMajdi Ashchi, DO, FACC, FSCAI, FSVMB, FABVM
Medical Director

What are the carotid arteries? The carotid arteries are the blood vessels that carry oxygen-rich blood away from the heart to the head and brain. Located on each side of the neck, these arteries can easily be felt pulsating by placing your fingers gently on either side of your windpipe. The carotid arteries are essential as they supply blood to the large front part of the brain.

Another smaller set of arteries, the vertebral arteries, are located along the back of the neck adjacent to the spine, and supply blood to the back of the brain.

Carotid Artery Disease Overview

What is carotid artery disease? Carotid artery disease is defined by the narrowing or blockage of this artery due to plaque build-up. The process that blocks these arteries is called atherosclerosis. The slow build-up of plaque is caused by high blood pressure, diabetes, tobacco use, high blood cholesterol and other modifiable & non-modifiable risk factors. Over time, this narrowing may eventually become so severe that blockages decrease blood flow to the brain and may cause a stroke. A stroke can also occur if a piece of plaque or a blood clot breaks off from the wall of the carotid artery and travels to the smaller arteries of the brain.

Brain cells deprived of fresh blood for more than a few minutes will be damaged, a condition known as “ischemia,” or the brain cells may die, a condition known as “infarction.” When blood flow to the brain is blocked, the result is sometimes called “an ischemic event.” This could be a stroke, which is permanent loss of brain function, or a transient ischemic attack (or TIA), which implies a temporary alteration of brain function. Brain damage can be permanent if this event lasts for more than three to six hours.

Stroke can also occur from causes other than carotid artery disease. For example, from heart disease (heart valve problems, heart failure, or patent foramen ovale (PFO) – which is a hole in the heart or atrial fibrillation – or if bleeding occurs in brain tissue. Nevertheless, carotid artery disease is one of the most common causes of stroke. According to the National Stroke Council, more than half of the strokes in the United States occur because of carotid artery disease.

Symptoms of Carotid Artery Disease

What are the symptoms of carotid artery disease? For many individuals, the first obvious sign often is a TIA or mini-stroke. Symptoms for a stroke or TIA are similar and may include:

  • blurring, dimming or loss of vision
  • tingling around the mouth
  • difficulty with speech
  • the inability to normally move an arm or leg
  • the inability to feel (numbness) in a part of the body
  • and rarely, a sudden severe headache

 

The difference between a stroke and a TIA is that the symptoms of a TIA are not permanent and can last from a few minutes to 24 hours. A TIA is a very powerful warning sign; although the symptoms may resolve completely, the occurrence of a TIA offers an individual who is at risk of a permanent stroke an extra opportunity to take actions. However, a TIA should still be treated as a medical emergency.

Diagnosis of Carotid Artery Disease

How is carotid artery disease diagnosed? The diagnosis of carotid artery disease is usually based on the performance of an ultrasound study of the neck arteries. Alternatively, the artery can be visualized by a magnetic resonance angiogram (MRA), CTA scan angiography or standard angiogram.

Treatment of Carotid Artery Disease

How is carotid artery disease treated? Treatment for carotid artery disease normally consists of normalization of those risk factors that cause artery blockages, specific medications (usually antiplatelet medications, cholesterol medications), and sometimes requires either carotid artery angioplasty and or stent, or by a surgical procedure (CEA =carotid endarterectomy). Anyone with any degree of narrowing of a carotid artery, or with any history of stroke or TIA, should quit use of all tobacco products, control their high blood pressure, normalize their blood cholesterol and blood sugar by diet and medications, and exercise regularly. Your doctor may prescribe a daily antiplatelet medication, such as aspirin, Plavix, Aggrenox or warfarin to reduce clot formation. The choice of medications is best made by your own physician.

Individuals with severe blockages of the carotid artery (usually greater than 70 percent blockage) may be recommended CEA. During this procedure, the plaque from inside the artery wall will be surgically removed and the blood flow is restored to normal. CEA procedure can be performed through a small incision, and in some cases under regional anesthesia. Most patients can go home the morning after the surgery. Recovering from surgery is usually rapid and people can quickly resume their normal activities without any restrictions. CEA entails general anesthesia, albeit small but there will be a scar in the neck, and will still need to be hospitalized for a day. Risks associated with traditional surgery are the usual anesthesia type risks, mild increase in occurrence of heart attacks, hematoma in the neck, small risk for stroke or TIA, risk for paralysis of vocal cord or laryngeal nerve palsy, infection or cellulitis in the incision site, etc.

A new “nonsurgical” endovascular treatment uses angioplasty and stents to open blocked carotid arteries. This procedure’s safety and efficacy has been tested in both high risk and standard risk patients, and is equivalent and non-inferior to traditional carotid artery surgery and does NOT involve general anesthesia, scar, or any risk to vocal cord paralysis or laryngeal nerve palsy. There are fewer heart attacks with stents in high and traditional (moderate) risk patients. The rest of the risks of this procedure are basically the same as traditional surgery.

Carotid Stent procedure (CS) involves the placement of a small flexible tube into an artery from the groin. The catheter is then directed to the neck to reach the carotid artery blockage.  A balloon pushes open the artery wall and a stent (a small metallic coil) is often less to keep the artery open. We have always used latest in equipment and technology including the embolic protection devices. Centers that do this procedure have been selected by rigorous process. Dr. Ashchi has a long history of performing CS procedure (1997) and have been among the leading physicians in many carotid clinical trials with excellent results. Each center must be CMS approved for this procedure. It must be realized that the number of procedures done by a physician matter in outcome. High volume centers, like Memorial Hospital Jacksonville, and high volume operators will have the lowest complications.

Stay healthy through exercise and proper nutrition and take all medications as your doctor prescribes. If you have risk factors for carotid artery disease, talk with your healthcare professional. If you have any symptoms, see help immediately as minutes are critical to your health.

To find out if you are a candidate for treatment or for more information, please call Ashchi Heart & Vascular at (904) 222-6656.