Carotid Artery Disease

The carotid arteries are the two blood vessels located on either side of the neck that deliver oxygen-rich blood to the brain. There is one carotid artery on each side of the neck and it can be felt with a finger below the jaw bone. When one of these vessels becomes narrowed, bits and pieces of plaque can shed to the brain. A plaque rupture can cause abrupt, complete closure of the carotid artery. This often leads to a stroke (sometimes called a brain attack).

Carotid Artery Symptoms

If blood flow to part of your brain stops, even very briefly, you may have symptoms of a stroke or “mini-stroke.” Seek medical help right away, even if the symptoms last for only a moment. The symptoms you may experience depend on the location of the blocked brain blood vessel.

These symptoms include:

Numbness or weakness in your arms or legs, usually on one side only
Sudden changes in vision or loss of vision in one eye - often like a window shade being pulled down on one eye
Slurring your words
A facial droop
Difficulty finding words and expressing yourself

These symptoms may last for only minutes, sometimes hours, or they are permanent. Even if you feel back to normal, contact your doctor immediately. Any of these symptoms may be a sign of a transient ischemic attack (TIA) or stroke. This means the risk for a permanent, devastating stroke is high.

How Carotid Arteries Become Blocked

High blood pressure, diabetes, and other health problems, along with smoking and a fatty diet, can cause a fatty substance called plaque to develop. As people age, plaque can build up inside their arteries. Over time, these plaques collect on arterial walls. As the plaques enlarge and build-up, the arteries become narrow and inflexible. This is a process called atherosclerosis, or "hardening of the arteries." These narrowed arteries can shed plaque and block blood flow, preventing parts of your brain from getting enough blood and oxygen to work normally.

In addition, plaque buildup makes the artery's walls rough, which can cause blood clots, also called emboli, to form. This emboli can break off, travel through the carotid artery, and enter the smaller vessels in your brain. If the emboli are large enough, they can block blood flow and cause a stroke. Emboli that have traveled into the brain can cause a mini-stroke (TIA) or stroke.

Carotid Artery Tests

Evaluation for carotid artery disease involves a thorough medical exam. Your doctor will first question you on your complete medical history. Tell your doctor about your symptoms. Include any numbness, vision difficulties, or weakness. Also tell your doctor about other health problems that can increase your risk of stroke, such as smoking, high blood pressure or diabetes, and about any health problems exhibited by other members of your family.

After the medical history is complete, your doctor will perform a complete physical evaluation. Some carotid artery blockages can be heard by listening with a stethoscope to the blood flow in your neck. A narrowing in the artery creates a characteristic "swooshing" sound called a bruit. Your eyes also may be examined (usually by an opthamologist or eye doctor) for tiny spots in their blood vessels. These spots (Hollenhorst plaques) can be a sign of carotid artery problems. Your doctor also may test your reflexes and strength. If a bruit is heard or if your doctor suspects a carotid artery blockage because of the symptoms that you describe, he or she will order an imaging test to determine whether a blockage is present. This could be an ultrasound test, an angiography or an MRA.

Doppler/Duplex Ultrasound Tests

In an ultrasound test, the sonographer or doctor uses sound waves to make images of your carotid arteries (ultrasound). During the test, a special sensor is gently pressed to the side of your neck. An image of the artery and the blood flowing through it shows how severe the narrowing is.

CT Angiography

In a CT angiography, a doctor uses a special contrast “dye” and x-ray images to make a map of your carotid artery. During this test, you lie in a scanner while a contrast dye is injected into a vein in your arm. The scanner then takes detailed pictures of the arteries.

Other Imaging Tests

A magnetic resonance angiography (MRA) makes an image of your carotid artery without using x-rays. Brain imaging tests can show damage from a past stroke. Any of these tests will provide your doctor with the information to determine the severity of the narrowing.

Treatment Options

If you have carotid artery disease, your doctor will likely talk to you about ways to prevent the progression of the disease. One of the most important treatments for carotid artery disease is the prevention of further narrowing or hardening of the arteries. Many of these preventative treatments include lifestyle changes. During your medical evaluation, you and your doctor will discuss lifestyle changes that will prevent the worsening of carotid artery blockages. Some methods to prevent worsening blockages include:

Treating High Blood Pressure (Hypertension) - Evidence supports that high blood pressure leads to cholesterol deposits in the carotid arteries, which directly correlates to a greater chance of stroke. If your blood pressure is high, your doctor will choose one of many blood pressure-lowering medications to treat your hypertension and, if needed, discuss methods to lose weight or incorporate exercise into your treatment program.
Quitting Smoking
Smoking damages blood vessels and causes cholesterol deposits to form. In order to prevent blockages from worsening, smokers must stop. And long-time smokers, take heart. The high risk of stroke observed among smokers returns to that of nonsmokers within 5 years of quitting
Treating Diabetes
Diabetics have a 4 times higher risk of carotid disease and stroke. They are also likely to have high blood pressure and high cholesterol.
Treating High Cholesterol
Because cholesterol deposits lead to plague buildup on the artery walls, your doctor will recommend treatments to lower your cholesterol levels. Changing your diet, losing weight, and exercising are some important ways to control your cholesterol level. If narrowing is already present, you may also be prescribed a statin, which is a cholesterol-lowering medication.
Blood Thinners
Blood thinners are part of a class of medicines called anticoagulant. Blood thinners do not really thin your blood. Instead, they block the function of platelets and reduce the ability of platelets to stick together and form a clot. Aspirin, clopidogrel and aggrenox are examples of anti-platelet blood thinners.
Carotid Endarterectomy
If you have had mini-strokes, or if your arteries have narrowed to a dangerous degree, your doctor may recommend a carotid endarterectomy. Carotid endarterectomy is an operation in which a surgeon removes plaque from the carotid artery. Whether you need surgery depends on your symptoms and how severely narrowed your carotid artery is. In many cases, surgery won’t be needed. Your doctor may decide that watchful waiting is a better alternative.

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