Carotid Artery Disease Care
Carotid artery disease, also known as carotid artery stenosis, is a narrowing of the carotid arteries commonly caused by a build-up of plaque (fatty deposits).
Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke.
Approximately 75% of all ischemic strokes occur in the distribution of the carotid arteries in the neck. Commonly, a piece of the plaque that develops in the carotid artery breaks off and travels to the brain causing either transient ischemic attack (TIA) or stroke.
Detecting and Diagnosing Carotid Disease
Carotid disease is usually discovered either because a patient experiences symptoms or because a physician listens over the neck and hears an abnormal sound called a bruit during a routine physical examination. It is important to recognize the symptoms that may signal an oncoming stroke so that medical care can be started as soon as possible.
The most common method of diagnosing carotid artery disease is duplex ultrasound. Duplex ultrasound is a non-invasive method of imaging the arteries to determine whether there is significant plaque.
Occasionally other studies may be needed, such as an MR angiogram, CT angiogram or a traditional contrast angiogram. When performed by trained ultrasound technicians in an accredited diagnostic vascular ultrasound laboratory such as the one at UC San Diego Health, carotid duplex ultrasound is extremely reliable. In most cases, this is the only study needed for planning surgical treatment.
Carotid Artery Disease Treatment
Carotid artery disease may be treated by medical therapy, surgery or by a combination depending on your situation.
In recommending treatment for a patient, your physician considers these factors:
- Whether or not you have symptoms
- How much narrowing (stenosis) is present according to ultrasound or angiogram tests
During a carotid endarterectomy, your surgeon will remove plaque that has built up inside the carotid artery. A cut (incision) is made on the side of the neck over the affected carotid artery.
The artery is opened, and the plaque is removed. Then the artery is stitched back together. This restores normal blood flow to the brain. You may have this procedure while you are awake under local anesthesia or while you are asleep under general anesthesia.
Carotid Artery Stenting
Carotid artery stenting is used to open up a narrowed carotid artery. A stent is a tiny, metal mesh coil that props open the artery so blood can flow freely.
During the procedure, a long thin tube (catheter) is inserted into an artery. This lets the doctor move tools through the artery to put the stent in place.
Stenting is often done with an angioplasty. For angioplasty, the doctor inflates a tiny balloon at the tip of the catheter at the blocked part of the artery.
The inflated balloon presses the plaque against the artery wall. This opens the artery for better blood flow. The doctor then places the stent to help keep the artery open.