Vascular Health Conditions: Carotid Disease « QA Categories

What can be done if my Carotid Disease needs an operation?
The most important principle of surgery for carotid disease is to open the blockage without dislodging the plaque into the artery itself. Two options exist:

Open surgery – called carotid endarterectomy. This uses a small incision in the neck directly over the carotid artery. The artery is then opened and the plaque is removed entirely from the artery.

Carotid stent – using an arterial catheter inserted in through the skin in the groin (in a similar fashion as those getting a heart stent), a stent can be placed within the carotid plaque. Using an angioplasty balloon, the stent is deployed so that it both opens the plaque and maintains the opening over time.

Patients do very well with both surgeries. However, both surgeries carry rare, but potentially serious, complications. While it is appealing to be able to treat the carotid stenosis with a stent and avoid open surgery, the most recent studies have shown a higher risk of atherosclerotic material getting up into the brain with stenting procedures than with open surgery (stroke rates are higher with stenting). Stenting has a somewhat lower risk of heart attack during the operation. The typical carotid artery surgical incision is not very uncomfortable, with the great majority of patients going home the morning after their open surgery. Most experts agree that stenting is best for those patients who have compelling reasons not to operate. These include previous neck radiation, severe fixed curvature of the spine in the neck, or heart or lung disease severe enough to make the risk of surgery higher.

Our vascular surgeons offer both stenting and open surgery and can recommend the best treatment for you.

Is there anything I can do about my Carotid Disease?

Once the plaque is there, only surgery can remove it. However, steps towards slowing the growth in the blockage can help reduce your chances of stroke. First and foremost: stop smoking! We know that smoking can accelerate the growth of the plaque that causes carotid disease, as well as cardiovascular disease throughout all of the arteries in your body. Maintaining healthy blood pressure and cholesterol levels is also very important. Consulting with your doctor for medications to achieve the best levels of blood pressure and cholesterol (good and bad forms) may also be necessary.

If you have diabetes, work with your doctor to control your diabetes and manage your cholesterol levels. Diabetes is known to increase the risk of arterial disease. If you have diabetes, your cholesterol level needs to be lower than levels for a person without diabetes.

If Carotid Disease can lead to stroke, why not fix it right away?
A large amount of research has been done to find the optimum timing for surgery. Despite what seems like a dangerous condition to have, research has shown that immediately fixing the carotid artery does not always benefit a patient. Some factors to consider:

We know that the risk of stroke increases with the amount of blockage – smaller blockages have low risk of stroke.

The benefit of surgery is to prevent a likely stroke.

The surgery itself can cause stroke and does not completely eliminate the risk of stroke after it is done.

Therefore, it makes sense to only operate on carotid blockage when the risk of a stroke is high. If it is not high, the risk of surgery is worse than the risk of having a stroke while watching the blockage over time. This timing may be affected by other factors (whether you’ve had a stroke or TIA already, whether your surgical risk is high). A vascular expert is trained to determine the optimal course of action for you.

I have Carotid Disease. What do I do now?

Having carotid disease is a risk for stroke, but not an absolute. We know that the risk of stroke increases directly with the amount of blockage (the more the blockage the higher the risk of stroke). The blockage grows very slowly and can usually be followed. In many cases, the most important thing to do is consult with your doctor and usually consult with a vascular surgeon. For many patients, close follow-up with surveillance ultrasounds is all that is necessary. The vascular surgeon can determine the schedule of ultrasounds (usually once or twice yearly), and can determine if and when surgery is necessary to fix the carotid disease.

Do I have Carotid Disease? How would I know?

Carotid disease without stroke or TIA (Transient Ischemic Attack) is usually completely without symptoms (asymptomatic). It may be discovered by your doctor hearing whooshing noises (sometimes called a “bruit”) over the arteries in your neck, but otherwise may produce no other symptoms you would notice. Carotid disease is usually discovered and confirmed by a test called duplex ultrasound. Other tests may include CT scans or MRI. Screening ultrasounds discovers some carotid disease. Find out if a screening ultrasound makes sense for you.

What are the symptoms of stroke or TIA?
Stroke can be caused by many factors (not just carotid disease). As a result there are many different symptoms of stroke. However the type of stroke from carotid disease usually results in specific symptoms:

Weakness or paralysis on one side of the body or one limb (people may describe this as their hand or leg going “dead”)

Numbness in the arm or leg (much more so than, say, your hand going to sleep when you lie on it in bed)

Facial droop on one side of the face

Inability to speak (this is a very dramatic change in speech – usually complete inability to speak, severe slurring, or inability for others to understand you).

Loss of vision in ONE eye (people describe this as a “shade” being drawn down over one eye

If you experience any of these symptoms, you should seek EMERGENCY medical attention immediately! They may be signs of a stroke.

Some symptoms that may have other causes than carotid disease include: dizziness, blurred vision in both eyes, headaches, or fainting. While these may also be serious conditions, they may not be a result of carotid disease.

What is the difference between a stroke and a “mini-stroke?”

If the debris that travels to the brain is small enough that it only temporarily blocks the artery, it will only momentarily cause damage. This is called a Transient Ischemic Attack (TIA) or “mini-stroke”. TIA symptoms typically last for up to an hour, by which point symptoms completely resolve. However, an embolus that causes permanent damage to a part of the brain results in a stroke, and this will usually result in long-lasting symptoms.

How does Carotid Disease lead to stroke?

Stroke from carotid disease usually results from a partial, and not a complete, blockage of the arteries. This partial blockage results in high velocity turbulence in the blood. The turbulence in turn leads to debris forming from the blockage; as blood continues to course up to the brain, some of this debris may break loose and travel into the brain. If this debris (called an embolus) lodges in the small arteries of the brain, it will block that artery causing a lack of blood flow. That part of the brain will suffer damage as a result.

What is Carotid Disease?

The carotid arteries are the blood vessels that travel from the heart through the neck into your brain. They supply the brain tissue with the oxygen and nutrients it needs to survive and function. Disease of the carotid arteries results from a blockage in them, almost always from thickening and hardening (atherosclerosis) of the arteries. This results in plaque buildup in the arteries. More uncommon carotid artery disorders include carotid dissections, which are tears in the inner lining of the blood vessel, and fibromuscular dysplasia, which can cause narrowing of the artery in the absence of atherosclerosis.

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