Carotid Artery Disease Care

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.

Diagnostic Methods

The most common method of diagnosing carotid artery disease is duplex ultrasound, a noninvasive imaging technique to determine whether there is significant plaque in the arteries.

Occasionally, other studies may be needed, such as an MR angiogram, CT angiogram or a traditional contrast angiogram.

When a carotid duplex ultrasound is performed by trained ultrasound technicians in an accredited diagnostic vascular ultrasound laboratory such as the one at UC San Diego Health, the technique is extremely reliable. In most cases, a duplex ultrasound is the only study needed for planning surgical treatment.

Carotid Artery Disease Treatment

Carotid artery disease may be treated by medical therapy, surgery or 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

Carotid Endarterectomy

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 the artery open so blood can flow freely.

During the procedure, a long, thin tube (catheter) is inserted into an artery. This allows the doctor to pass instruments through the artery to place the stent.

Stenting is often performed 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 dilates the artery, improving blood flow. The doctor then places the stent to help keep the artery open.