Carotid Artery Disease

Basic Facts

  • Carotid artery disease is the narrowing or blockage of the arteries (one on each side of the neck) that supply oxygen-rich blood to the brain.
  • A primary cause of carotid artery disease is atherosclerosis, which is the buildup of cholesterol and fat (plaque) on the artery walls.
  • Carotid artery disease is a major cause of stroke, which occurs if the blood flow to the brain is interrupted or cut off.
  • Carotid artery disease is a type of peripheral arterial disease, which is blockage of the arteries that carry blood from the heart to the limbs, head and organs.

There are two carotid arteries (one on each side of the neck) that supply blood to the front part of the brain, where thinking, speech, personality, and sensory and motor functions reside.

Carotid artery disease is caused by the same factors that contribute to coronary 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.

Many people with carotid artery disease have no symptoms. However, some people experience a warning sign called a transient ischemic attack (TIA) beforehand if an artery to the brain becomes blocked. 

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 face or body or in one arm or leg,
  • Temporary loss of control of movement in one arm or leg, and/or
  • 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.

 

Atherosclerosis is the cause of carotid artery disease, and the buildup of plaque progresses to varying degrees in many of the body's major arteries. 

Patients are at increased risk for developing carotid artery disease and stroke if they already have coronary heart disease or have a family history of heart disease or stroke.
Other factors that increase a person’s risk include:

  • Smoking
  • High cholesterol levels or lipid disorders - High levels of cholesterol in the blood can increase the risk of plaque buildup. 
  • High blood pressure - Uncontrolled high blood pressure can result in hardening and thickening of the arteries, narrowing the channel through which blood can flow.
  • Diabetes 
  • Male gender
  • Heart disease
  • Advanced age
  • Obesity and lack of exercise
  • Alcohol and drug abuse

A buildup of plaque in a carotid artery can narrow the space through which blood flows.

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 - With this test, painless ultrasound waves allow doctors to measure the speed of blood flow and to create pictures of the inside of the carotid arteries. 
  • Arteriogram – Also called angiogram, this test uses an injection of dye (contrast material) into an artery in combination with imaging techniques (x-ray, MRI or CT scan), resulting in detailed images that can show narrowing or blockages. 

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. 

Medication such as aspirin or other antiplatelet medicines can help prevent obstruction of the carotid arteries, as well as cholesterol-modifying medications or lipid therapy, which helps lower the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the “bad”) cholesterol. 

Coronary Interventions

Sometimes more aggressive treatment is needed to restore and improve blood flow to the brain. These option might include: 

  • Angioplasty and Stenting - During this non-surgical procedure, a balloon attached to a small catheter is inflated within an artery to flatten the plaque against the artery wall, increasing the artery's diameter. In most cases, a stent, a metal-mesh tube, is expanded and left inside the artery to support the expansion and maintain blood flow.
  • Carotid Endarterectomy – With this surgical procedure, plaque is removed from the inner lining of the carotid arteries. 

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,
  • Controlling high blood pressure,
  • Lowering cholesterol,
  • Exercising,
  • Losing weight,
  • Controlling diabetes, and 
  • Reducing alcohol intake.