Carotid artery disease is a common problem and a major cause of stroke. Patients are at increased risk for developing carotid artery disease and stroke if they already have coronary artery arteriosclerotic heart disease or have a family history of heart disease or stroke. Carotid artery disease is caused by the same factors that contribute to coronary artery arteriosclerotic heart disease, but tends to develop later in life. Fewer than one percent of adults in their 50s have significant narrowing of their carotid arteries. But 10 percent of adults in their 80s have extensive narrowing

Atherosclerosis cannot be prevented altogether, but progression of the disease can be slowed or the risk of developing atherosclerosis can be reduced through changes in lifestyle and diet. The best preventive measures are exercising regularly, eating a diet low in cholesterol and saturated fat, and maintaining a healthy weight. A class of drugs called statins can reduce the amount of cholesterol in the bloodstream and may limit the growth of plaque.

WHAT ARE THE SYMPTOMS?

Many people with carotid artery disease have no symptoms. Not everyone who has a stroke because of carotid artery disease experiences a warning sign called a transient ischemic attack (TIA) beforehand. Whether a patient has warning symptoms depends mainly on whether the plaque surface has become soft or cracked. Unfortunately, a stroke is often the first symptom of carotid arteriosclerosis.

The classic symptoms of TIA because of carotid artery disease are:

• Partial loss of vision in one eye;
• Weakness, tingling, or numbness that comes on without apparent cause on one side of the body or in one arm or leg;
• Temporary loss of control of movement in one arm or leg; and
• Inability to pronounce words or speak clearly.

These warning symptoms clear up on their own within minutes of onset, leaving no residual effects. They should always be considered potentially serious and should be promptly reported to a doctor. These are also symptoms indicative of a stroke if they lasted for an interval longer than a few hours.

CAUSES AND RISK FACTORS

Atherosclerosis is the cause of carotid artery disease. With age, fatty deposits called plaque build up inside the walls of the arteries, causing them to narrow. This progressive disease process occurs to varying degrees in many of the body’s major arteries. Atherosclerosis is at the root of most arterial disease, including carotid artery disease.

Factors that increase a person’s risk for carotid artery disease include:

• Smoking;
• High blood pressure;
• Diabetes;
• Male gender; and
• Family history of atherosclerosis.

DIAGNOSIS

To diagnose carotid artery disease, the physician will first obtain a detailed description of the patient’s symptoms. The physician may use a stethoscope to listen to the carotid arteries on both sides of the neck to detect a “bruit” or “whooshing” sound caused by turbulent blood flow in a narrowed carotid artery. Blood pressure measurement in both arms is also an important part of evaluating carotid artery disease to detect possible narrowing in other branches of the blood vessels of the upper body.

Depending on the results of the patient’s history and findings from the physical exam, the physician may order the following tests:

• Carotid Duplex Ultrasound;
• Transcranial Doppler Ultrasound;
• Computed Tomography (CT) Scan;
• Magnetic Resonance Angiography (MRA); and
• Arteriography.

TREATMENT APPROACH

How carotid artery disease is treated depends on the patient’s symptoms, the status of all blood vessels supplying blood flow to the brain, and the degree of narrowing in the carotid artery. Not all cases of carotid artery disease require either a surgical or interventional procedure to treat them. If the patient has been referred to a vascular specialist, chances are there is extensive narrowing, or stenosis, of the carotid arteries. The disease is usually treated if there is evidence of a TIA and a significant lesion in the artery. Sometimes patients with a history of prior stroke who remain at risk for further stroke are also treated. If the carotid disease does not require direct treatment, lifestyle changes and medication can be used to try to limit the growth of plaque. Another important part of non-operative management is to make sure the patient and immediate family members understand the warning signs of TIA.

Invasive treatment methods include:?Carotid Endarterectomy. Carotid endarterectomy is the most commonly used procedure for removing plaque from the inner lining of the carotid arteries. This surgical procedure is the traditional, favored treatment for carotid disease. A surgeon exposes the carotid artery through an incision in the neck. Sometimes a small tube is inserted into the normal segment of carotid artery below and above the narrowed segment, bypassing the blood around the part of the carotid artery to be cleaned out. In other cases, the collateral blood flow from other arteries is sufficient that a shunt is not needed. The carotid artery is then opened, and the lining and the plaque it contains is carefully and precisely removed to leave a smooth, wide-open artery. Afterward, the artery is stitched shut, and the shunt (bypass) tube, if used, is removed. Recovery is rapid, and the patient may be able to leave the hospital the day after the procedure.

Angioplasty and Stenting. Angioplasty and stenting are minimally invasive techniques performed using local anesthesia. Angioplasty involves threading a balloon-tipped catheter through an artery in the groin and into the narrowed area of the carotid artery. Inflating the balloon expands the artery, effectively opening it. Today, physicians also insert a stent, a tiny metal mesh tube that serves as scaffolding to hold the artery open, in nearly 100 percent of carotid procedures.

Lifestyle changes. As with many cardiovascular conditions, lifestyle factors can contribute to carotid artery disease. The first step a patient should take is to modify any behavior that increases the risk for carotid artery disease. Some of these changes should include:

• Quitting smoking;
• Losing weight;
• Exercising regularly;
• Reducing cholesterol and saturated fat intake; and
• Reducing alcohol intake.