Carotid Artery Disease: Causes, Symptoms, Tests, and Treatment

Medically Reviewed by Dr. K. Updated as of May 20, 2021.

Carotid Artery Disease

Carotid artery stenosis is another name for carotid artery disease. The narrowing of the carotid arteries is referred to as carotid stenosis. Plaque, an accumulation of fatty substances and cholesterol deposits, is the most common source of narrowing. A total blockage of the carotid artery is referred to as a carotid artery occlusion. When the carotid arteries get clogged, you're more likely to have a stroke. There are over 13.7 million new strokes each year. Globally, one in
four people over age 25 will have a stroke in their lifetime, according to the World Stroke Organisation.

What Are the Carotid Arteries?

The carotid arteries are two large blood vessels that provide oxygenated blood to the brain, neck, and face. Thinking, speech, personality, as well as sensory and motor functions, are all areas of the brain in which blood supply originates from the carotid arteries. The carotid arteries are on either side of your body, just below the angle of your jaw line, where you can sense your pulse.

How Does Carotid Artery Disease Develop?

The carotid arteries, like the coronary arteries that supply blood to the heart, may experience atherosclerosis, or “hardening of the arteries," on the inside of the vessels.

The carotid arteries shorten when fatty substances and cholesterol accumulate over time. This reduces cerebral blood pressure and raises the chance of a stroke.

A stroke, also known as a “brain attack," is a type of heart attack. It happens when blood supply to a portion of the brain is shut off. The damage is normally irreversible if the loss of blood supply persists more than three or six hours. A stroke can occur if one or more of the following conditions exist:

  • The artery narrows significantly.
  • There is a rupture in an artery that has atherosclerosis leading to the brain.
  • A piece of plaque falls off and flows to the brain's smaller arteries.
  • A blood clot forms in a blood artery and obstructs it.

Strokes may happen for a number of reasons other than carotid artery disease. A stroke may be caused by spontaneous bleeding in the brain, such as intracerebral haemorrhage. Other causes contributing to strokes are:

  • Subarachnoid haemorrhage: a form of sudden bleeding in the spinal fluid space.
  • Atrial fibrillation: a condition in which the heart beats irregularly.
  • Cardiomyopathy: a disease that affects the heart.
  • High blood pressure
  • Blockage in small arteries within the brain.

What Are the Risk Factors for Carotid Artery Disease?

Carotid artery disease has contributing factors that are identical to other forms of heart disease. They are as follows:

  • Age
  • Smoking
  • Hypertension (high blood pressure)
  • Abnormal lipids or high cholesterol
  • Insulin resistance
  • Diabetes
  • Obesity
  • Sedentary lifestyle
  • Family history of atherosclerosis, either coronary artery disease, carotid artery disease or peripheral vascular disease

Men under the age of 75 are at a higher risk than women of the same age. Women over the age of 75 are at a higher risk than men of the same age. Carotid artery disease is most likely to occur in people who have coronary artery disease. The carotid arteries start developing disease a few years after the coronary arteries.

What Are the Symptoms of Carotid Artery Disease?

You may not even be aware that you have carotid artery disease. Plaque forms in the carotid arteries over time, with no symptoms before a transient ischemic attack (TIA) or stroke occurs.

Symptoms of a stroke include:

  • Visual loss (blindness), distorted vision, or difficulties looking out of either or both eyes may occur suddenly.
  • Weakness, tingling, or numbness to one side of the face, one side of the body, or in one arm or leg.
  • Loss of balance and coordination, leading to difficulties in walking.
  • Dizziness
  • Difficulty speaking (called aphasia)
  • Confusion
  • Sudden severe headache
  • Problems with memory
  • Difficulty swallowing (called dysphagia)

What Is a Transient Ischemic Attack (TIA)?

A TIA occurs when blood flow to the brain is reduced or when a clot prevents an artery supplying blood to the brain for a short period of time. You can have the same effects as you did if you had a stroke if you have a TIA. However, the signs only last a few minutes or hours before disappearing.

Since it is difficult to determine when a TIA would turn into a big stroke, it is a medical emergency. If you or someone you meet is experiencing some of the symptoms mentioned above, seek immediate medical attention. Treatment as soon as possible will save your life and improve your chances of a complete recovery.

According to the findings, anyone who has had a TIA is ten times more likely to have a large stroke than someone who has not had a TIA.

How Is Carotid Artery Disease Diagnosed?

Until you get a TIA or a stroke, you may not notice the symptoms of carotid artery disease. That's why it's important to visit a doctor for health screening on a frequent basis. A stethoscope may be used by your doctor to listen to the arteries in your spine. A bruit, or erratic echo, detected over an artery could indicate irregular blood flow. This may be a symptom of carotid artery disease.

While it does not detect all blockages, listening for a bruit in the neck is an easy, secure, and inexpensive way to scan for carotid artery stenosis (narrowing). Some researchers agree that bruits, rather than stroke risk, are stronger predictors of atherosclerotic disease. If you've had some of the symptoms mentioned above, be sure to tell your doctor.

A test can be used by the doctor to detect carotid artery disease. The following are few examples of possible tests:

  • Carotid ultrasound (standard or Doppler): The carotid arteries are viewed using high-frequency sound waves in this noninvasive, painless screening test. It examines the arteries for plaques and blood clots, as well as when they are restricted or blocked. The flow of blood into the blood vessels is visualised with a Doppler ultrasound. X-rays are not used in ultrasound imaging.
  • Magnetic resonance angiography (MRA): A strong magnet is used in this imaging method to collect accurate information regarding the brain and arteries. The data is then used by a computer to create high-resolution pictures. Even minor strokes in the brain will also be detected with an MRA.
  • Computerized tomography angiography (CTA): A CT scan combines X-rays and computer technologies to generate cross-sectional images of the carotid arteries that are more accurate than an X-ray. Images of the brain may also be obtained. The scan can show areas of brain damage with this imaging test. The CT scan emits a small amount of radiation.
  • Cerebral angiography (carotid angiogram): The gold standard for imaging the carotid arteries is this procedure. It's an experimental operation that allows a specialist to see real-time blood flow across the carotid arteries. When contrast dye is pumped into the carotid arteries, cerebral angiography helps the doctor to see narrowing or blockages on a live X-ray tube. This technique yields the most accurate results. There is a small chance of major complications.

What’s the Treatment for Carotid Artery Disease?

Doctors prescribe the following treatments to successfully treat carotid artery disease:

Following recommended lifestyle changes.

  • Taking medications as prescribed.
  • If your doctor thinks this can better reduce your chances of a potential stroke, you should consider doing a procedure to increase blood flow.

What Are the Recommended Lifestyle Changes for Carotid Artery Disease?

The following dietary changes are prescribed to prevent carotid artery disease from progressing:

  • Quit smoking.
  • Manage high blood pressure.
  • Control diabetes and blood sugar levels.
  • Have regular screenings with your doctor.
  • Have your doctor check your cholesterol and get treatment, if necessary.
  • Eat a balanced heart healthy diet.
  • Maintain a healthy weight. Lose weight where necessary.
  • Exercise at least 30 minutes, at least 5 days of the week.
  • Limit alcohol to 1 drink per day for women, 2 for men.

Which Drugs Can Reduce the Risk of Stroke?

To reduce the risk of stroke induced by blood clots, your doctor may prescribe antiplatelet medications such as aspirin and clopidogrel (Plavix). Medications to reduce cholesterol and blood pressure may also be prescribed by the doctor. Warfarin (Coumadin), a blood thinner, may be prescribed in certain cases.

What Medical Procedures Treat Carotid Artery Disease?

A surgery may be performed to clear the carotid artery whether it is severely narrowed or blocked. This would improve blood supply to the brain, reducing the risk of a potential stroke. Each of the following procedures may be recommended by your doctor:

  • Carotid endarterectomy (CEA): For patients with carotid atherosclerosis and TIAs or minor strokes, this has become the standard procedure. An incision is placed in the neck at the site of the blockage when you are under general anaesthesia. The artery is isolated, and the plaque and diseased parts of the artery are surgically removed. The artery is then sewn back together, allowing for better blood supply to the brain. The dangers and advantages of CEA vary depending on your age, the degree of blockage, and whether you've suffered a stroke or a transient ischemic attack (TIA).
  • Carotid artery stenting (CAS): A newer treatment method is carotid artery stenting (CAS). It's a less invasive procedure than carotid endarterectomy, because it's done in a catheterization lab. A minor puncture in the groin is made with CAS. A catheter of a particular structure is inserted through the narrowed section of the carotid artery. A tiny balloon tip is inflated for a few seconds until the device is in position to clear the artery. After that, a stent is inserted into the artery and expanded to leave it in place. A stent is a thin tube that serves as a scaffold within the artery to provide support. The stent is normally constructed of metal and is designed to last a lifetime. It may also be composed of a material that is absorbed by the body over time. Some stents include drugs to prevent the artery from being blocked again. Since CAS is a newer treatment, there is also some debate over how effective it is at preventing strokes triggered by carotid artery disease. According to research, the standard CEA is possibly better than CAS, which may increase the risk of stroke or death after the operation.

Source:

Referenced on 26/4/2021

  1. World Stroke Organization https://www.world-stroke.org/assets/downloads/WSO_Global_Stroke_Fact_Sheet.pdf 
  2. American Heart Association: “Carotid Artery Stenosis.”
  3.  National Heart Lung and Blood Institute: “Carotid Ultrasound.” 
  4. JAMA: “Guarding Against Stroke – What You Should Know About Carotid Artery Disease.” 
  5. National Cholesterol Education Program: “High Blood Cholesterol: What You Need to Know.” 
  6. National Institute of Neurological Disorders and Stroke: “Questions and Answers about Carotid Endarterectomy.” 
  7. Stroke: “Carotid Stenting Versus Endarterectomy for Asymptomatic Carotid Artery Stenosis."
  8. https://www.webmd.com/heart-disease/carotid-artery-disease-causes-symptoms-tests-and-treatment

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