Carotid Artery Disease: Symptoms, Diagnosis, Treatment and Prevention – Advancing Treatment of Stroke and TIA
What are the carotid arteries?
The carotid arteries are the blood vessels that carry oxygen-rich blood away from the heart to the head and brain. Located on each side of the neck, these arteries can easily be felt pulsating by placing your fingers gently on either side of your windpipe. The carotid arteries are essential as they supply blood to the large front part of the brain.
Another smaller set of arteries, the vertebral arteries, are located along the back of the neck adjacent to the spine, and supply blood to the back of the brain.
What is carotid artery disease?
Carotid artery disease is defined by the narrowing or blockage of this artery due to plaque build-up. The process that blocks these arteries is called atherosclerosis. The slow build-up of plaque is caused by high blood pressure, diabetes, tobacco use, high blood cholesterol, and other modifiable and none-modifiable risk factors.
Over time, this narrowing may eventually become so severe that blockages decrease blood flow to the brain and may cause a stroke. A stroke can also occur if a piece of plaque or a blood clot breaks off from the wall of the carotid artery and travels to the smaller arteries of the brain.
Brain cells deprived of fresh blood for more than a few minutes will be damaged, a condition known as “ischemia” or the brain cells may die, a condition known as “infarction”. When blood flow to the brain is blocked, the result is sometimes called “an ischemic event”. This could be stroke, which is permanent loss of brain function, or a transient ischemic attack (or TIA), which implies a temporary alteration of brain function. Brain damage can be permanent if this event lasts for more than 3 to 6 hours.
Stroke can also occur from causes other than carotid artery disease, for example, from heart disease (heart valve problems, heart failure, PFO or patent foramen ovale which is a hole in the heart or atrial fibrillation) or if bleeding occurs in brain tissue. Nevertheless, carotid artery disease is one of the most common causes of stroke. According to the National Stroke Council, more than half of the strokes in the United States occur because of carotid artery disease.
What are the symptoms of carotid artery disease?
For many individuals, the first obvious sign often is a TIA or mini-stroke. Symptoms for a stroke or TIA are similar and may include blurring, dimming, or loss of vision; tingling around the mouth, difficulty with speech, the inability to normally move an arm or leg, the inability to feel (numbness) in a part of the body, and rarely, a sudden or severe headache. The difference between a stroke and a TIA is that the symptoms of a TIA are not permanent and can last from a few minutes to 24 hours. A TIA is a very powerful warning sign; although the symptoms may resolve completely, the occurrence of a TIA offers and individual who is at risk of a permanent stroke an extra opportunity to take action. However, a TIA should still be treated as a medical emergency.
How is carotid artery disease diagnosed?
The diagnosis of carotid artery disease is usually based on the performance of an ultrasound study of the neck arteries. Alternatively, the artery can be visualized by a magnetic resonance angiogram (MRA), CTA scan angiography or standard angiogram.
How is carotid artery disease treated?
Treatment for carotid artery disease normally consists of normalization of those risk factors that cause artery blockages, specific medications (usually antiplatelet medications, cholesterol medications), and sometimes requires either carotid artery angioplasty and/or stent, or by a surgical procedure (CEA=Carotid Endarterectomy). Anyone with any degree of narrowing of a cortid artery, or with any history of stroke or TIA, should quit use of all tobacco products, control their high blood pressure, normalize their blood cholesterol and blood sugar by diet and medications, and exercise regularly.
Your doctor may prescribe a daily antiplatelet medication, such as aspirin, Plavix, Aggrenox or Warfarin to reduce clot formation. The choice of medications is best made by your own physician. Individuals with severe blockages of the carotid artery (usually greater than 70 percent blockage) may be recommended CEA. During this procedure, the plaque from inside the artery wall will be surgically removed and the blood flow restored to normal. CEA procedure can be performed through a small incision, and in some cases under regional anesthesia. Most patients can go home the morning after the surgery. Recovering from surgery is usually rapid and people can quickly resume their normal activities without any restirctions. CEA entails general anesthesia albeit small but there will be a scar in the neck, and will still need to be hospitalized for a day. Risks associated with traditional surgery are the usual anesthesia type risks, mild increase in occurrence of heart attacks, hematoma in the neck, small risk for stroke or TIA, risk for paralysis of vocal cord or laryngeal nerve palsy, infection or cellulitis in the incision site, etc.
A new “nonsurgical” endovascular treatment uses angioplasty and stents to open blocked carotid arteries. This procedure’s safety and efficacy has been tested in both high risk and standard risk patients, and is equivalent and non-inferior to traditional carotid artery surgery and does NOT involve general anesthesia, scar, or any risk to vocal cord paralysis or laryngeal nerve palsy. There are fewer heart attacks with stents in high and traditional (moderate) risk patients. The rest of the risks of this procedure are basically the same as traditional surgery.
Carotid Stent procedure (CS) involves the placement of a small flexible tube in to an artery from the groin. The catheter is then directed to the neck to reach the carotid artery blockage. A balloon pushes open the artery wall and a stent (small metallic coil) is often left to keep the artery open. We have always used the latest in equipment and technology including the embolic protection devices. Centers that do this procedure have been selected by a rigorous process. First Coast Heart & Vascular Center physicians have a long history of performing CS procedure and have been among the leading physicians in many carotid clinical trials with excellent results. Each center must be CMS approved for this procedure. It must be realized that the number of procedures done by a physician matter in outcome. High volume centers, like Memorial Hospital Jacksonville, and high volume operators will have the lowest complications.
Prevention of Carotid Artery Disease
Stay healthy through exercise and proper nutrition and take all medications as your doctor prescribes. If you have risk factors for carotid artery disease, you should talk with your healthcare professional. If you have any symptoms, see help immediately as minutes are critical to your health.
Choosing a Doctor for a Stenting Procedure
When a patient is a candidate for the carotid stenting procedure, there are certain criteria to consider. Patients need to know how many carotid stenting procedures a physician has performed and look for experienced doctors who have completed at least 100 procedures with low complication rates. A doctor should be knowledgeable and using all types of embolic protection devices. These devices are used to prevent debris or clots from traveling to the brain during the procedure and causing TIA or stroke. Dr. Van Crisco and Dr. Michael Seawell at First Coast Heart & Vascular Center have been involved in hundreds of carotid angioplasty and stent procedures. First Coast Heart & Vascular works as a team, we provide an extra level of expertise, discussing complicated cases with one another to achieve the best possible result for each patient. Along with our commitment to excellence comes a low incidence of complications — we have a rate of complications that is less than the national average.
Post-Operative Patient Care
First Coast Heart & Vascular Center willingly shares the most up-to-date scientific knowledge about cardiovascular topics with other physicians in the community through educational lectures and by permitting doctors from other practices to observe various surgical procedures. being asked by another doctor for our help with a procedure or with their patient is a high compliment, and we are glad to assist.
Follow-up care is an essential component of First Coast Heart & Vascular Center’s patient care. The practice offers accredited vascular technologists, along with an accredited vascular lab, to monitor patients for restenosis and progression of the disease.
At-risk patients are urged to see their primary care doctors for yearly full exam including listening to the neck for carotid bruits (Bruit-noise made in part by a blocked or tortuous artery). This is a potentially life-saving step. Early detection of severe disease can allow us to address the condition before it causes TIA, stroke, or death.