Carotid Artery Disease

The major arteries of the neck, the carotid arteries, supply the brain with blood and extend from your aorta in your chest to the brain inside your skull. Carotid artery disease occurs when these arteries become narrowed or blocked.  This is a serious health problem because it can cause a stroke.

Symptoms of Carotid Artery Disease
Most patients do not know they have carotid artery disease, as it is often asymptomatic (without symptoms).  Even though it may be asymptomatic, carotid artery disease can still lead to stroke.

Occasionally, carotid artery disease may cause warning symptoms of a stroke, which are called transient ischemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and include:

• Weakness, numbness, or a tingling sensation on one side of your body
• Loss of control of the movement of an arm or a leg
• Losing vision in one eye (many people describe this sensation as a window shade coming down)
• Being unable to speak clearly

Causes of Carotid Artery Disease
In most cases, the cause of carotid artery disease is atherosclerosis.  Risk factors include:

• History of smoking
• High cholesterol
• High blood pressure
• Diabetes
• Family history of hardening of the arteries

Less common causes include fibromuscular dysplasia, carotid artery dissection and carotid aneurysms.

What to Expect at Your Medical Exam

1. Your vascular surgeon will try to determine if you do have carotid artery disease, as well as the best method of treatment.  This evaluation will include questions about the history of your symptoms and your general health.
2. Your vascular surgeon will also conduct a physical examination, including listening for a bruit, an abnormal sound related to blood circulation.  This abnormal sound may signal narrowing of the artery.
3. After the history and exam, if your vascular surgeon suspects you have carotid artery disease, he or she may schedule a carotid Duplex ultrasound. This noninvasive test is an ultrasound of your neck, which measures the degree of narrowing in the arteries of the neck.  This test is usually sufficient to diagnose carotid artery disease.  However, your vascular surgeon may need to order further tests.  These may include:

• Magnetic resonance angiography (MRA)
• Computerized tomographic angiography (CTA)
• Angiography

Treatments for Carotid Artery Disease
Based on your symptoms and depending on the severity of the blockage, your vascular surgeon will recommend treatment.  For less severe stenosis, the treatment includes lifestyle modification, such as smoking cessation, and medication, including aspirin and anti-cholesterol medications.  

Surgery
Surgery may be recommended based on the degree of narrowing and the severity of your symptoms. 
Your vascular surgeon may recommend either of the following surgical procedures to treat your carotid artery disease:

• Carotid endarterectomy
• Angioplasty and stenting