Carotid artery disease, also called carotid artery stenosis or carotid artery occlusive disease, is characterized by the narrowing of the carotid arteries, the main blood vessels for carrying oxygenated blood to the brain. This is most commonly related to atherosclerosis (a build-up of plaque) in the artery. If the narrowing becomes severe enough to block blood flow to the brain, or if a piece of plaque breaks off and obstructs blood flow, a stroke may occur.
The Division of Vascular and Endovascular Surgery within the Brigham and Women’s Hospital (BWH) Heart & Vascular Center provides advanced diagnosis and treatment for patients with carotid artery disease. State-of-the-art techniques, including endovascular treatment of carotid artery disease, are available for our patients. As a regional, national, and international referral center, we have broad experience in managing vascular problems, ranging from the most common to the rare and complex. Twenty-four-hour consultation is available for urgent or emergency problems.
Atherosclerosis is the most common cause of carotid artery disease, although it is not clear what causes this build-up of plaque. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to the brain.
Risk factors associated with atherosclerosis include:
When plaque 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 condition. There are many potential warning signs for stroke, including:
Other potential warning signs for stroke include blackout spells or severe headaches.
At BWH, our carotid artery disease specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. 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 (abnormal sound heard through a stethoscope) in the neck, caused by disturbed blood flow through the carotid artery.
When a medical 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. Asymptomatic patients with severe carotid artery narrowing are selectively recommended for intervention based on their age and overall health status.
Specialists from the Division of Vascular and Endovascular Surgery develop individualized treatment plans for patients based on:
Carotid artery disease (asymptomatic or symptomatic) that involves a less than 50 percent narrowing of the carotid artery is usually treated medically. Along with a modification of lifestyle risk factors, this may include:
For more severe carotid artery narrowing, there are two options. Currently, most patients are recommended standard open surgical treatment of the carotid narrowing:
A new, minimally invasive treatment for carotid artery narrowing, which may be offered to patients on a selective basis, is:
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.
The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.
The day of surgery, you care will be provided by surgeons, anesthesiologists and nurses who specialize in surgery for patients with carotid artery disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.
In addition to our vascular and endovascular surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiac surgeons, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.
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