Carotid artery disease, also called carotid artery stenosis, is the narrowing or blockage of the carotid arteries, usually caused by atherosclerosis.
Atherosclerosis is the buildup of cholesterol, fat and other substances traveling through the bloodstream. These substances stick to the blood vessel walls over time as people age, and combine to form a material called plaque.
Plaque buildup can lead to narrowing or blockage in the carotid artery which, when significant, can put an individual at increased risk for stroke.
Small arteries of the brain can get blocked by clots or pieces of plaque which break off from the walls of the carotid artery. This can restrict or stop blood flow to the brain resulting in a TAI or Transient Ischemic Attack which temporarily affects brain function. It could also result in a stroke which is permanent loss of brain function.
NOTE: If you already have peripheral arterial disease (PAD) or coronary heart disease you are at higher risk of carotid disease and stroke. Others can be modified such as smoking, high cholesterol, high blood pressure, family history of stroke or angina or diabetes.
What Are the Carotid Arteries?
The carotid arteries are the blood vessels that carry oxygen-rich blood to the head, brain and face. They are located on each side of the neck. The carotid artery divides into the internal carotid artery and the external carotid artery. The internal carotid arteries supply oxygen-rich blood to the brain. The external carotid arteries supply oxygen-rich blood to the face, scalp, and neck. One can feel the pulse in the carotid arteries on each side of the neck, right below the angle of the jaw line.
What is a stroke?
A stroke, or “brain attack,” occurs when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing surrounding nerve cells to be cut off from their supply of nutrients and oxygen.
A stroke also can occur as a result of other conditions, such as sudden bleeding in the brain (intracerebral hemorrhage), sudden bleeding in the spinal fluid space (subarachnoid hemorrhage), atrial fibrillation, cardiomyopathy, or blockage of the tiny arteries inside the brain.
Signs and symptoms of a stroke or CAD 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, fating or loss of balance
- Sudden, severe headache with no known cause
1. Carotid Endarterectomy
Carotid endarterectomy is a surgical procedure to remove the plaque. A skin incision is made in the neck and the carotid artery is located. Temporary clamps are placed across the artery above and below the area of stenosis to stop blood flow. During this time, the carotid artery on the other side of the neck carries blood flow to the brain. The surgeon makes an incision in the artery over the blocked area. The plaque buildup is physically peeled out and removed. The artery is then closed with tiny sutures and the clamps removed to allow blood flow to the brain.
Carotid endarterectomy is typically indicated for patients who have had symptoms (stroke or TIA) and have blockage greater than 50%. It is also recommended for patients who have no symptoms (asymptomatic) and have blockage greater than 60%.
2. Carotid Angioplasty and Stenting
This is used in cases where blockage is difficult to reach through carotid endarterectomy. A tiny ballon which is threaded by a catheter to the blockage area is inflated once in place. The inflation helps in widening the artery and to help it in such a position a tiny wire mesh coil called a stent is inserted. A relatively simple and less risky procedure, this is done under local anesthesia.
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