Carotid artery disease

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MayoClinic.com Carotid Artery Stenting information

What is a stroke
What is a transient ischemic attack
What are the symptoms of TIA or stroke
What can I do to prevent the development or progression of carotid artery disease
Are there medications for carotid artery disease
How will I know if I have carotid artery disease
How is carotid artery disease treated
Which treatment is right for me
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The carotid arteries are the blood vessels located on both sides of your neck that carry blood to the head and brain. Carotid artery disease is the build up of plaque in these arteries, causing a narrowing or blockage of the artery. This is usually due to atherosclerosis or “hardening of the artery”. Carotid artery disease can lead to a stroke or Transient Ischemic Attacks (also called TIAs or mini-strokes).

Carotid artery disease is a frequent source of stroke. The lining of a normal carotid artery is smooth, but the inner walls of arteries narrowed by atherosclerosis can be very rough or irregular because fatty material called plaque collects inside the artery. Special components of the blood called platelets can clump on this irregular surface. Small pieces of plaque or platelet clots can then travel to the brain, blocking blood flow to a portion of the brain and causing a stroke.

What is a stroke?

A stroke occurs when a part of the brain is without blood for a prolonged period of time. That part of the brain becomes permanently injured, causing difficulty with movement of the arms or legs, speech or vision. The specific disability that results is dependent upon which part of the brain and how large an area is affected. A stroke can occur without any warning, or may be preceded by transient ischemic attacks (TIAs). The symptoms of stroke and TIAs are the same, but strokes last for longer than 24 hours, while TIAs generally resolve within minutes to hours.

What is a transient ischemic attack?

Sometimes called a mini-stroke, a transient ischemic attack (or TIA) is the temporary blockage of blood to a portion of the brain (or eye) that results in specific warning signs similar to stroke symptoms (see below). The symptoms last less than a day, and generally this does not result in permanent injury to the brain. Although these symptoms resolve quickly, they are an important sign that someone is at high risk to develop a full-blown stroke if ignored.

What are the symptoms of TIA or stroke?

When the blood flow to a portion of the brain is interrupted, any of the following symptoms can occur alone or in combination.

Numbness, weakness, ad/or loss of coordination or paralysis of the arm or leg on one side of the body
Drooping on one side of the mouth or face
Blindness or loss of part of the vision in one eye (this may appear like a shade being drawn over the eye)
Difficulty speaking or inability to speak or understand written or spoken words

Other symptoms of a more global nature are sometimes related to stroke. Brief periods of memory loss, loss of consciousness, or brief periods of dizziness can be related to carotid artery disease. These more global symptoms are usually due to something else, but evaluation of the carotid arteries is frequently part of the investigation into these symptoms.

If you develop any of these symptoms, you should seek medical attention immediately. Certain medicines used in the treatment of stroke can only be given within several hours of the onset of symptoms. For this reason, time is of the essence when these symptoms develop. People frequently ignore stroke like symptoms because they feel fine aside from the difficulty with their arm or leg. They think it will go away by itself. Ignoring the symptoms may limit the treatments available for the stroke.

What can I do to prevent the development or progression of carotid artery disease?

Atherosclerosis is the causative factor for carotid artery disease, as well as for heart disease and for peripheral vascular disease. Certain risk factors for atherosclerosis are unavoidable. For example, as you get older you are more likely to develop atherosclerosis. If you have an extensive family history of heart disease, stroke or diabetes, you are at increased risk for the development of atherosclerosis. While it is important to understand these factors, they cannot be changed.

However, there are important lifestyle factors under your control that can influence the development or progression of atherosclerosis. Adopting a healthy lifestyle can reduce your risk of atherosclerosis and its complications, including stroke, heart attack and limb loss.

Stop Smoking: This is the single most important thing you can do to improve the health of your arteries. Smoking works in a number of ways to injure your body, including causing the blood vessels to constrict, decreasing the amount of oxygen in your blood, increasing your blood pressure, and increasing the chances of blood clot formation. Any form of tobacco or nicotine can have these effects. There are support groups to assist those wishing to quit, and your doctor can help with certain medications and other quitting aids.

Healthy Eating: A low-fat, high-fiber diet can keep your arteries healthy. Limiting cholesterol in your diet by avoiding animal fat, egg yolk, red meats and dairy products can help to lower your blood cholesterol level. Choosing foods like fat-free milk, skinless chicken breast or fish instead of other animal based products can keep your cholesterol under control. Addition of whole-grain products such as whole wheat bread, brown rice, or oatmeal can also help. Restricting your intake of sodium can also be an important consideration in managing your blood pressure or heart disease. If you are overweight, losing a few pounds can also help in managing your cholesterol, blood pressure, and blood sugar, not to mention decreasing the stress on your back and joints.

Exercise: Regular, daily exercise aids in the control of atherosclerosis. It is not necessary to exercise vigorously. Mild exercise, such as walking, is generally safe and helpful to most people, but needs to be done on a regular basis to decrease the risk of disease. Try to do some form of exercise every day. You should consult your care provider before doing any more strenuous forms of exercise.

Are there medications for carotid artery disease?

The best medical therapy for prevention of stroke from carotid artery disease is anti-platelet therapy. For most patients, this consists of taking one aspirin a day. For others with more advanced disease, your doctor may add Plavix (clopidigrel). These medications can prevent the accumulation of platelets on the irregular surface of the plaque. Equally important however, is taking all of the necessary medications for any other related health problems you may have.

High blood pressure: Uncontrolled high blood pressure (hypertension) adds to the workload of the heart, and is associated with the progression of atherosclerosis. It also increases the risk of smaller strokes unrelated to carotid artery disease. Since hypertension is often without symptoms, your blood pressure should be checked regularly. If your care provider has prescribed medication for high blood pressure, you should take these as ordered, even if you feel good. Hypertension is usually not able to be cured, so medication is frequently required indefinitely.

Diabetes: People with diabetes are especially prone to atherosclerosis. Following through with diet, treatment, and medication programs is important to minimize the effects of diabetes on your blood vessels, kidneys, eyes, and nerves. With strict management, the effects of diabetes can be controlled.

High blood cholesterol: Controlling your blood cholesterol may not be possible with diet alone. Medications used for lowering blood cholesterol have been effective in preventing the progression of atherosclerosis and its complications.

How will I know if I have carotid artery disease?

Most often, carotid artery disease is silent and unsuspected. Occasionally, the narrowed arteries produce a noise that can be heard with a stethoscope over the neck. If your care provider suspects that you have carotid artery disease, she will ask you specific questions, examine you, and may order one of the following special tests. Carotid Duplex Imaging is a painless, safe procedure which uses sound waves to obtain pictures of the carotid artery and examine the blood flow through it. The degree of carotid artery narrowing can be accurately estimated from this information. Frequently, this is the only test your care provider will need to decide on a treatment plan. This test generally takes less than 1 hour to perform. If more information is needed about the blood vessels inside the chest or head Computed Axial Tomography (CAT scan) may be obtained. This is an x-ray study usually performed with intravenous contrast to enhance the pictures. Aside from the intravenous catheter, this is a painless study that can provide high resolution pictures of just about any artery in the body. The test is obtained by lying on a table that moves through a machine housing the x-ray unit. The test takes less than 1 hour and has only slight risks associated with the use of intravenous contrast and x-rays. Other tests may be obtained to look at the arteries in special circumstances, including Magnetic resonance angiography (MRA) which uses radio waves and magnetic energy or a conventional Angiogram which uses a series of X-ray images with contrast injected into the arteries to show the flow of blood.

How is carotid artery disease treated?

The treatment for carotid artery disease depends on the severity of the stenosis found in the carotid artery, the symptoms you have experienced, and your overall state of health. Mild or moderate stenosis may be treated with medication and by reducing as many risk factors as possible to slow the growth of the stenosis. Your care provider will discuss the importance of reducing your risk factors and regular medical follow-up. More severe carotid artery stenosis may sometimes be treated with an operation know as carotid endarterectomy. This is a surgical procedure in which the plaque and inner lining of the artery is removed. An incision is made, the carotid arteries are located; clamps are placed above and below the surgical site; the carotid artery is opened; and the plaque is carefully removed. The artery is then closed with a patch of a vein or an artificial/synthetic material; sutures or staples are applied to the skin and the area is covered with a dressing. In certain instances, it may be possible to treat carotid stenosis through catheters inserted in the groin with stents placed in the carotid artery to improve the flow through the region. This approach is very new and the devices have only recently been approved for use by the FDA. As the technology develops, more and more patients will be candidates for this procedure.

Which treatment is right for me?

The best treatment for carotid artery disease depends on a number of factors, including the size and location of the stenosis, whether or not it is causing symptoms, and the age and general health of the patient. You should discuss all of these factors and any other questions you have with your primary care physician.