Risk Factors for Carotid Artery Occlusive Disease
The carotid arteries are paired arteries in the neck that serve as the major blood supply to the brain. The major risk factors for carotid artery occlusive disease include atherosclerosis or "hardening of the arteries" elsewhere in the body, a history of smoking, diabetes, and high cholesterol levels.
Carotid Artery Narrowing and Stroke
When atherosclerosis builds up in the carotid artery, blood flow to the brain may be impaired, increasing your risk of stroke. A stroke is damaged brain tissue caused by a vascular problem. There are many potential warning signs for stroke. These warning signs are termed "transient ischemic attacks" (TIA) and include:
- A sudden weakness or even paralysis of a leg, arm, or hand.
- Transient slurring, garbled or inappropriate speech.
- Transient blindness or severe blurring of vision in one eye.
- A transient one-sided facial droop.
Other potential warning signs for stroke include blackout spells or severe headaches.
There are a variety of important aspects to long-term stroke prevention. Complete smoking cessation combined with aggressive treatment and management of health problems related to atherosclerosis such as high blood pressure, diabetes, and high cholesterol levels is essential. Most patients with mild carotid artery narrowing should be treated with long-term daily aspirin therapy.
Diagnosis of Carotid Artery Occlusive Disease
The presence of a carotid artery narrowing may be suggested by one of the warning signs described above. Many patients, however, will be completely asymptomatic despite significant narrowing of a carotid artery. In many such patients, a careful physical examination will reveal the presence of an audible bruit in the neck due to disturbed blood flow through the carotid artery. This may be detected with a careful physical examination using a stethoscope.
When the patient's history or physical examination suggests potential carotid artery narrowing, the patient is generally sent for a noninvasive imaging study to evaluate the carotid arteries. These studies may include a duplex ultrasound study or a magnetic resonance angiogram. Both are completely noninvasive and highly accurate tests to determine the presence and extent of carotid artery narrowing. When a carotid artery narrowing of greater than 80 percent is found, consideration for repair of the artery is appropriate. Patients who have had warning signs for stroke and are found to have significantly narrowed carotid arteries are recommended for artery repair. Patients who who no symptoms are selectively recommended intervention for severe carotid artery narrowing based on their age and overall health status.
Treatment of Carotid Artery Occlusive Disease
There are two options for the management of carotid artery narrowing. Currently, most patients are recommended standard open surgical treatment of the carotid narrowing. This operation, called carotid endarterectomy, is performed through a small incision in the neck and involves a "shelling out" of the plaque from the diseased artery. This procedure removes the plaque from the inside of the artery wall and restores normal blood flow through artery to the brain. The operation is generally well tolerated and involves a one to two day hospital stay.
A new, minimally invasive treatment for carotid artery narrowing, which may be offered to patients on a selective basis, is balloon stent angioplasty of the narrowed vessel. This procedure does not require incision in the neck and can be performed through a catheter introduced through the groin artery. This procedure also involves a one day hospital stay. After either standard carotid endarterectomy or balloon stent angioplasty, patients are followed with serial duplex ultrasound studies to monitor the progress of their carotid arteries.
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