Carotid Interventions

1) What is Carotid Artery Disease?
Carotid artery disease is a disease that affects the blood vessels leading to the head and brain (cerebrovascular disease). Like the heart, the brain's cells also need a constant supply of oxygen-rich blood for efficient functioning. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of our neck. If these arteries become clogged or blocked, we can have a stroke.
Carotid artery disease is usually caused by atherosclerosis, which is a hardening and narrowing of the arteries. As we grow in age, fat deposits, cholesterol, calcium, and other materials build up on the inner walls of the arteries. This build-up forms a wax-like substance called plaque. As the plaque builds up, the arteries become narrower, and the flow of blood through the arteries becomes slower.
Lifestyle changes, medicines, transcatheter interventions, or surgery can be used to treat carotid artery disease and lower your risk of a stroke.

2) Who is at risk for carotid artery disease and stroke?
Aging is a primary predictor of increased incidence of stroke. If you have carotid artery disease, you probably also have severe coronary artery disease or have a parent who died from coronary artery disease. So, the risk factors for carotid artery disease are similar to those for coronary artery disease:

  • High levels of low-density lipoprotein cholesterol (bad cholesterol) and triglycerides in the blood.
  • High blood pressure
  • Diabetes
  • Smoking
  • Family history of coronary artery disease
  • Obesity
  • Lack of exercise

3) What are the signs and symptoms of Carotid Artery Disease?
The carotid artery is the large artery whose pulse can be felt on both sides of the neck under the jaw. The main carotid artery bifurcates into the internal and external carotid arteries. The internal carotid artery supplies blood to the brain, and the external carotid artery supplies blood to  the face. This bifurcation is usually a common site for atherosclerosis, an inflammatory buildup of  plaque that can narrow the lumen of the common or internal carotid arteries.
Clinically, the risk of stroke from carotid stenosis is evaluated by the presence or absence of symptoms and the degree of stenosis on imaging. Few symptoms are:

  • Temporary episodes of headache,
  • Dizziness, tingling, numbness
  • Blurred vision, confusion, or paralysis that can last anywhere from a few minutes to a couple of hours.

Other signs or symptoms of a carotid artery blockage may be

  • Weakness or paralysis of your arm, leg, or face on one side of your body.
  • Numbness or tingling of your arm, leg, or face on one side of your body.
  • Trouble swallowing.
  • Loss of eyesight or blurry eyesight in one eye.
  • Dizziness, confusion, fainting, or coma.
  • Sudden, severe headache with no known cause

4) What are the symptoms of Carotid Artery Disease?
You may not know you have carotid artery disease until something goes wrong. Often a stroke victim will have no warning symptoms. However, some patients do experience warning signs in the form of a transient ischemic attack (TIA), sometimes referred to as a "mini-stroke."
TIA symptoms, as for a stroke, include numbness or paralysis (usually on one side of the body), difficulty speaking or understanding, and temporarily dimmed or blurred vision. These symptoms resolve within a few minutes or hours, but they are your body's warning to contact your physician right away.

5) Are there any treatment options for Carotid Artery Disease?
If you are diagnosed with carotid artery disease, more treatment options are available now than ever before. Advances in treatment for heart disease are successfully being applied to carotid artery disease. Your physician may prescribe treatments as simple as lifestyle changes or medication.
For patients who have  serious blockage in a carotid artery, a physician may recommend reopening the artery through a procedure called angioplasty. During angioplasty, a thin tube called a catheter is inserted into the artery and a small balloon opens to expand the blocked artery. Your physician will also usually place a stent, a tiny mesh tube, in the artery to help keep it open. Alternately, a surgical procedure called carotid endarterectomy may be indicated. During this surgery, an incision is made in the carotid artery to remove the blockage

6) How is carotid artery disease diagnosed?
In most cases, physicians can tell if you have the disease during a normal checkup. Your doctor may ask if you have had symptoms of a stroke (muscle weakness or numbness, lightheadedness, or trouble talking or seeing). By placing a stethoscope over the carotid artery in your neck, your doctor can listen for a rushing sound, called a bruit. But, the results of this test can be misleading. Bruit sounds may not always be present, even when carotid artery disease is severe. Also, bruit sounds are sometimes heard when blockages are only minor.
Other diagnostic tools include

  • A carotid ultrasound uses harmless sound waves to create pictures of the inside of your carotid arteries. A separate test called a Doppler ultrasound can be used to image blood flow through the carotid arteries. Together, these tests can identify narrowing in the carotid arteries. This effective test poses no radiation risks and is painless.
  • Computed tomography (CT) angiography :During a CT scan, the patient lies on a table inside a tube. This tube takes detailed X rays of portions of the human body at different angles to form three-dimensional images. A CT scan can give your physician extensive information about where you may have narrowing in the carotid arteries. For the test, you may also be administered contrast dye, a substance that makes it easier to see the blood vessels. A CT scan uses radiation to form images, so the benefits and risks are weighed before this type of scan is performed.
  • Magnetic resonance angiography (MRA) : Magnetic resonance angiography (MRA) is an MRI that produces images of blood vessels in the body. MRA, similar to a CT scan, involves having a patient to lie on a moveable table that slides into a tube. The machine contains a large magnet that creates a magnetic field. Pulses of radio waves are then sent and received, and a computer interprets these signals and converts them to images. The images show "slices" or sections of the body. This test can sometimes view blood vessels more clearly than an ultrasound or CT scan.
  • Cerebral angiography: For this test, your physician will administer contrast dye, usually through a catheter inserted into a vein in the leg. X rays capture images of the dye traveling through the carotid arteries and indicate places where narrowing may be occurring

7) How does the brain get blood while the physician is operating on it?
There are several blood vessels capable of bringing blood to the brain while the operated artery is clamped for repair. The majority of patients (nearly 75% or more) will have adequate blood flow even with one carotid artery clamped to prevent injury. The brain can receive blood temporarily via a shunt (a plastic tube placed into the artery above and below that plaque) should it become necessary.