Carotid artery disease

Carotid artery disease, also called carotid artery stenosis, occurs when fatty deposits build up in within the artery developing plaques. These carotid plaques can cause the artery to become narrow, restricting blood flow to the brain. If this restriction of blood flow becomes too severe or if a bit of the plaque breaks off a stroke may occur.

Carotid artery disease: Symptoms

TIAs (transient ischemic attack) or strokes may occur as a symptom of carotid artery disease. A TIA differs from a stroke in that a TIA is a temporary deficit caused by slow blood flow to the brain whereas a stroke is typically a fixed or permanent deficit caused by death to brain tissue from lack of blood flow. A person who experiences a TIA is at a very high risk of experiencing a completed stroke and should be evaluated for possible carotid artery disease.

Carotid artery disease: Treatments

Carotid artery disease treatment is focused on preventing a stroke from occurring. Prior to evaluation for surgical intervention you may be initially treated with diet modification and/or medications that assist in lowering blood pressure, lowering cholesterol and preventing blood clots.

In the event conservative treatment is attempted and/or the amount of plaque stenosis is too great there may be discussion of intervention for your carotid artery disease. There are generally two methods of treatment: open revascularization or stent placement. The type of procedure chosen is based on a few factors including age, degree of vessel narrowing, history of prior stroke or TIA caused by carotid artery disease and risk factors based on past medical history.

Endovascular treatment

Endovascular treatments are performed from within the vessel, typically accessed at the femoral artery located at the groin or radial artery at the wrist from which catheters are advanced over a small wire to the carotid artery. In this procedure a balloon is typically inflated within the vessel (angioplasty) to open to vessel prior to stent placement.

You may be a candidate for carotid stenting performed using transcarotid artery revascularization (TCAR). This procedure is unique in that the artery is accessed at the base of the neck and blood flow is temporarily reversed during the procedure protecting the brain from any bits of plaque that may be broken off in traditional stenting cases.

These procedures typically require an overnight stay in the hospital however are generally tolerated well with little down time.

Surgical treatment

Carotid endarterectomy is an open surgical procedure for the treatment of carotid artery disease. Candidates for this procedure include those who have had an ipsilateral (same side) TIA or non-disabling stroke as the symptomatic event, high degree narrowing of the carotid artery without symptoms, a surgically accessible lesion (stenosis) and stable medical state in order to undergo anesthesia for procedure safely. During this surgery, the carotid artery is opened and the plaque is removed. This procedure typically requires a couple of days in the hospital however is generally tolerated well with little down time.