Carotid artery disease occurs when plaque builds up inside of the arteries. The most common location for carotid artery plaque to cause narrowing is just below the jaw bone.
Plaque is a sticky substance of cholesterol, calcium and fibrous tissue. Often, carotid plaque has a crumbling characteristic like broccoli or cauliflower. If pieces of the plaque break off into the bloodstream they can block blood flow to the brain. This can cause a section of the brain to stop functioning. If the blood flow is not restored in a matter of minutes, the damage to the brain can be permanent. If the blood flow is recovered and no brain cells are lost, the episode is considered a Transient Ischemic Attacks or TIA. When brain cell death occurs the patient is considered to have had a stroke. A stroke, commonly referred to as a cerebrovascular accident (CVA), may result in serious consequences such as long-term disability or even death. Some patients, thankfully, have complete recovery from a stroke. Many will suffer another TIA or stroke if the cause is not corrected. In general, the more severe the stenosis in the carotid artery, the higher the risk for stroke.
Who is at Risk?
People with a history of smoking, high cholesterol, high blood pressure, and diabetes. People with cardiac disease are also at risk for carotid disease. Another group of risk factors, known as metabolic syndrome, includes having abdominal obesity, high triglyceride level (a type of fat in the blood), low level of HDL (“good”) cholesterol, high blood pressure and high blood sugar.
You may not experience any symptoms of carotid artery disease, but your doctor may hear the sound of blood rushing, which is called a bruit, while listening with a stethoscope. Patients may experience weakness or complete loss of muscles function in either the left side or right side of the body or face. Other common symptoms are slurred speech, one sided facial drooping, or loss of vision in one eye which is often described as having a dark shade come over the eye. This referred to as amuarosis fugax. Amuatosis fugax usually occurs for only a few minutes and is caused by a blockage of blood to the retnia.
The most common test for evaluating carotid artery occlusive disease is duplex ultrasound. Less specific but also useful is the use of magnetic resonance angiography and CT angiography. Often, catheterization of the arteries with injection of x-ray contrast is performed to fully evaluate all of the blood vessels that supply the brain with arterial blood flow, including the aortic arch, the carotid arteries, the vertebral arteries and the arteries inside of the brain. This test is often referred to as a four vessel cerebral angiogram.
Testing can be done in the PVA Vascular Lab.
If your arteries are blocked, a surgical procedure called a carotid endarterectomy may be necessary to remove the artery’s inner lining.
Carotid Artery Angioplasty
Carotid artery angioplasty is a procedure to widen the arteries and then a stent (tube) is inserted to prevent the artery from narrowing or becoming blocked again. Individualized treatment should be tailored to best treat each patient. In some cases, no treatment is necessary. To date, there is no medical treatment of carotid artery disease.