Carotid Artery Disease, Stroke, TIAs

What is carotid artery disease?

Carotid artery disease develops when fat and cholesterol deposits, called plaque, build up and clog the carotid arteries, which deliver oxygen-rich blood to your head and brain.

There is a carotid artery on each side of the neck. Each of these arteries divides into an internal artery, which delivers blood to the brain, and an external artery, which supplies blood to the scalp, face, and neck.

Over time, plaque slowly builds in these arteries, which is a process called atherosclerosis. As the plaque builds, the arteries start to stiffen and narrow, reducing the blood flow through them. As the blockage of oxygen-rich blood to the head and brain gets worse, the risk for stroke increases.

Stroke

Strokes occur when the flow of oxygen-rich blood to the brain is blocked, and brain cells called neurons in the affected area begin to die. The longer the brain goes without the oxygen and nutrients it needs, the higher the risk of permanent damage. However, if treatment is given to open a blocked artery within the first four hours, the chances are better for making a full recovery.

The symptoms of a stroke appear in the parts of the body that the affected brain cells control. These symptoms develop suddenly and may include:

  • numbness or loss of movement in the face, arms, or leg, and often only one side of the body
  • weakness
  • dizziness or loss of balance
  • trouble speaking or understanding speech
  • problems with vision in one or both eyes
  • severe headache with no known cause

Strokes are a serious medical condition and require urgent treatment. If you believe you or someone you know is having a stroke, call 911 immediately.

In addition to developing because of the buildup of plaque, strokes can also occur if the plaque in an artery cracks or ruptures, causing a blood clot to form. Blood clots can also block arteries, or break off and flow through the blood stream and get stuck in a smaller artery in the brain, blocking blood flow.

Carotid artery disease is responsible for more than half of the strokes that occur in the United States each year, while strokes are the fourth most common cause of death and leading cause of permanent disability.

Risk factors for developing carotid artery disease include:

  • a family history of atherosclerosis
  • having coronary artery disease
  • age (risk is higher under age 75 for men; over age 75 for women)
  • smoking
  • high blood pressure
  • diabetes
  • high levels of LDL (bad)

Carotid artery disease can be prevented and is treatable, which can play a key role in helping to reduce your risk of having a stroke.

What are the symptoms of carotid artery disease?

Carotid artery disease may not show any signs or symptoms in its early stages. In fact, they may not develop until later, when a carotid artery is narrowed or blocked. However, there may be warning signs of a stroke—or a stroke may be your first sign of the disease.

Signs and symptoms of carotid artery disease or stroke may include:

  • a bruit, which is a vascular sound indicating a turbulent flow of blood caused by the narrowing of the carotid artery from plaque buildup; bruits are detected by the doctor with a stethoscope
  • transient ischemic attack (TIA), also known as a mini-stroke, which is an early sign of carotid artery disease and an important warning sign that you are at high risk of having a stroke. Though TIAs can have some or all of the symptoms of a stroke, they usually go away on their own within 24 hours; however, a TIA should be considered a medical emergency because you don’t know if it will progress into a stroke
  • stroke, which occurs when the flow of oxygen-rich blood to the brain is blocked, and brain cells in the affected area begin to die; the longer the brain goes without the oxygen and nutrients it needs, the higher the risk of permanent damage including paralysis (inability to move), vision or speech problems, or death

Symptoms that are common to both TIAs and stroke include:

  • numbness or loss of movement in the face, arms, or leg, often only one side of the body
  • weakness
  • dizziness or loss of balance
  • trouble speaking or understanding speech
  • problems with vision in one or both eyes
  • severe headache with no known cause

TIAs and strokes are serious medical conditions and require urgent treatment. If you believe you or someone you know is having a TIA or stroke, call 911 immediately. Do not drive yourself to the hospital.

Getting treatment right away can save your life and give you a better chance for a full recovery.

How is carotid artery disease diagnosed?

Because carotid artery disease doesn’t always have symptoms, you should talk to your doctor about any risk factors you might have. But if you do have symptoms, it’s important to see your doctor right away. Being open with your doctor and getting regular physical exams will increase your chances of the disease being found and treated early, before a stroke occurs.

Doctors diagnose carotid artery disease based on your medical history, a physical exam, and test results.
While discussing your medical history, your doctor will ask about any risk factors for carotid artery disease that you might have, whether there’s history of the disease in your family, any signs and symptoms you’ve experienced, and if you’ve ever had a TIA or stroke.

Next, the doctor will perform a physical exam. Using a stethoscope, the doctor will listen to the carotid arteries in your neck for signs of a bruit, which is an abnormal swooshing or rushing sound indicating reduced blood flow due to plaque buildup. The doctor may also test your physical strength and certain mental capabilities, such as speech and memory.

Finally, your doctor may request some tests to help confirm the diagnosis of carotid artery disease. These tests may include:

  • carotid ultrasound, which uses high-frequency sound waves sent through a small probe attached to the skin with gel to create images showing whether there is any narrowing in your carotid arteries, or how blood is moving through the arteries
  • carotid angiography, which involves inserting a long, thin, flexible tube called a catheter into a blood vessel in the arm or leg, then guiding it to the carotid arteries; a contrast dye is then injected into the catheter to highlight the arteries while x-rays are taken
  • computerized tomography (CT) scan, which uses a large machine with a big hollow ring in the middle and a table that you lay on; the table slowly slides into the scanner, where the x-ray pictures are taken of your carotid arteries from different angles
  • magnetic resonance imaging (MRI), which is a long tunnel-like machine with a sliding table you lay on; the machine uses magnets, radio waves, and a computer to capture images of your carotid arteries
  • CT or MRI angiography, which involves adding contrast dye to the tests to highlight carotid arteries on the captured images

How is carotid artery disease treated?

The main goals in treating carotid artery disease are to stop its progression and to reduce your risk of having a stroke. Your treatment will depend on the severity of blockage in your carotid arteries, any symptoms you may have, your age, and your overall health.

If your blockage is mild to moderate, your doctor my recommend lifestyle changes and medications. If your blockage is severe or if you’ve already had a TIA or stroke, medical procedures may be required to remove the blockage.

Lifestyle changes

These are things you can do on your own to slow the progression of atherosclerosis and limit your risk for developing carotid artery disease, or to stop it from getting worse. For some people, this may be the only treatment they need.

These lifestyle changes include:

  • eating a healthy, balanced diet (such as whole grains, vegetables, and fruits and foods that are low in cholesterol, sodium, and saturated and trans fat)
  • quitting smoking
  • managing high risk conditions (such as diabetes, high blood pressure, or high cholesterol) by lowering your glucose, blood pressure, and cholesterol levels
  • achieving and maintaining a healthy weight; losing excess weight will lower your total cholesterol and raise your good cholesterol
  • limiting your alcohol intake
  • exercising regularly (check with your doctor before starting an exercise program)
  • seeing your doctor for regular checkups

Medications

Sometimes lifestyle changes alone are not enough to stop carotid artery disease from getting worse. Underlying conditions such as diabetes, high cholesterol levels, and high blood pressure may require medications to help you achieve your treatment goals, such as:

  • anticlotting medications to prevent blood clots from forming in the carotid artery and causing a stroke; your doctor may recommend taking a daily aspirin or another blood-thinning medication
  • statins to lower cholesterol and help prevent further blockage in your blood vessels and strokes
  • anti-hypertensive medications to lower high blood pressure and keep it below levels based on your age and/or any related conditions you may have to reduce your risk of stroke
  • blood glucose medications to help control diabetes

Medical and Surgical procedures

For people whose blockage of the carotid artery is severe or who have already had a TIA or stroke, the following procedures are used to open blocked or narrowed arteries and allow blood to flow to the brain:

  • carotid endarterectomy, which involves making a small cut in the neck to reach the carotid artery, opening the artery where it is blocked, removing the lining of the artery, then closing the artery and cut in the neck with stitches. This is the most common treatment for severe carotid artery disease, and is performed while the patient is unconscious, so there is no pain.
  • carotid angioplasty, which involves threading a small tube through a blood vessel in the neck to the blocked or narrowed carotid artery; once there, a small balloon inside the tube is inflated to push the plaque against the artery wall. A small wire mesh tube called a stent is then inserted to keep the artery open. A local anesthesia is used for this procedure, meaning the patient is awake but doesn’t feel any pain.

Advanced Cardiovascular Care at Jeanes Hospital

If you're experiencing symptoms of carotid artery disease or warning signs of stroke, the academic-level vascular surgeons at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple vascular surgeons at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there’s no need to travel to another institution to have it done. Since 2006, Temple vascular surgeons have been performing vascular surgery and procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed here for the diagnosis and treatment of carotid artery disease and its related conditions include:

  • carotid stenting and angioplasty
  • clot removal or lysing
  • cryoplasty
  • diagnostic angiography

This is the level and quality of care you would expect to find downtown or in another city. Yet, it's available right here, in your own community.

To schedule an appointment with a vascular surgeon at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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