Carotid Artery Disease

There are four main vessels that provide blood supply to the brain. The vertebral arteries travel within the cervical spine in the back of the neck and enter the skull to feed the brain. The parts of the brain supplied by the vertebral arteries are responsible for a wide range of bodily functions, many of which are not under conscious control.

The carotid arteries are a pair of blood vessels, one on each side of the neck, within the soft tissues. If you feel a pulse in your neck, it is the carotid artery. These arteries begin in the chest as a single common carotid artery and then branch in the neck into internal and external carotid arteries. The external carotids supply muscles in the neck, face, and scalp but the internal carotid continues without any branches into the brain. When we talk about carotid artery disease, it is always in reference to the internal carotid artery because all symptoms and treatments are focused on this vessel.

What Is Carotid Artery Disease?

Carotid artery disease is also called carotid artery stenosis. Stenosis is the medical term for narrowing, or blockage and it can be used to refer to a blockage in any blood vessel. As in any blood vessel, the narrowing is caused by atherosclerosis, or build-up of plaque and hardening of the arteries. Atherosclerotic plaque is an accumulation of cholesterol within the wall of the artery. As the plaque builds up, the narrowing becomes more severe and the plaque is more likely to fracture, break off, and travel through the internal carotid artery to brain. This results in a stroke.

What Are Symptoms Of Carotid Artery Disease?

Vascular disease in other parts of the body is likely to cause symptoms as a blockage becomes more severe. In the legs, patients often notice progressive pain with walking. In the kidneys, arterial blockage may lead to high blood pressure or declining kidney function. In the intestines, one may develop abdominal pain after eating. The carotid artery is different in that the first indication of a problem may be a mini-stroke, or TIA (transient ischemic attack), or a major disabling stroke with permanent deficits.

Symptoms of TIA (mini-stroke):

By definition, symptoms of a TIA resolve completely within 24 hours of onset. In reality, most of the time, TIA symptoms resolve within a few minutes. If symptoms do not resolve within a day, a person is considered to have had a stroke. Symptoms depend on which part of the brain is affected, but when attributed to the carotid artery, they most commonly include one or more of the following:

-Temporary loss of vision

  **Many patients describe a “gray shade” coming down over the eye which resolves in a few minutes.

-Slurred speech

-Inability to speak or form words

-Numbness or tingling in an arm or leg

-Paralysis of an arm or leg

Stroke symptoms are identical, but may be more severe and do not resolve.

If any of these symptoms develop, you should call 911 immediately as it is not possible to predict whether a TIA will evolve into a major stroke and there are interventions which can be done if you reach the hospital in time.

How Is Carotid Artery Disease Diagnosed?

Carotid disease is usually diagnosed with a non-invasive ultrasound test called a carotid duplex exam. Ideally, carotid disease is identified before a patient has a TIA or stroke. Certain risk factors predispose to the development of carotid stenosis and in patients with risk factors, doctors may order a screening exam.

Risk factors include:

-Smoking

-Hypertension (high blood pressure)

-High cholesterol

-Coronary artery disease

-Family history of stroke

-History of head/neck radiation

Once diagnosed, carotid artery disease is classified as mild, moderate, and severe depending on the percent stenosis. Mild is 1-49%, moderate is 50-69%, and severe is generally considered any blockage over 70%.

How Is Carotid Disease Managed or Treated?

Patients with carotid disease should be evaluated by a vascular surgeon because surveillance is important. If a patient is found to have mild or moderate disease, generally surveillance ultrasounds should be performed every 6 months to one year. It is also important to start the proper medication regimen to decrease the chance of having a stroke and slow the progression of the disease. In some cases, it may be possible to avoid surgery completely.

Patients with high-grade or severe disease, or those who have had a TIA or stroke are generally considered for surgery.

Surgery For Carotid Disease

There are two options for treating carotid artery disease surgically.

Carotid endarterectomy, or CEA, is performed through an incision on the neck. The carotid artery is opened and the plaque is extracted. The artery is then patched to ensure it remains wide open.

Carotid artery stenting, or CAS, is a minimally invasive option where the carotid artery is stented.

Both procedures require admission to the hospital, usually for at least one day. There are many factors to consider when deciding which option is best. Drs. Albright and Levin perform carotid surgery and stenting and frequently counsel patients on non-operative management as well.

At Nevada Vein and Vascular, we perform carotid screening ultrasounds and offer all of our patients surveillance imaging in accordance with Society of Vascular Surgery guidelines.

If you or a family member has risk factors for carotid disease or have a history of TIA/stroke, please call us at (775) 323-3000 to schedule an appointment.

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