Carotid Artery Disease and Stroke

Every 45 seconds, someone suffers a stroke in the United States. It is the third leading cause of death behind heart disease and cancer. As our population ages, more individuals will be at risk for suffering a stroke. 2/3 of stokes are due to complications of hypertension, which is an elevation in blood pressure. 1/3 is due to peripheral vascular disease (arterial blockages) that forms in the main blood vessels that carry blood to the brain. These blood vessels are known as the carotid arteries. For this reason, control of blood pressure and surveillance for carotid artery blockage are the most effective means of avoiding stroke.

Blood is delivered from the heart to the brain through four arteries: two carotid arteries in the front of your neck, and two smaller vertebral arteries in the back. You can feel the carotid arteries by pressing gently on either side of your windpipe. When you feel your pulse, those are the carotid arteries. Atherosclerosis occurs when fat and cholesterol deposits (“plaque”) build up in your arteries. Plaque that develops in the carotid arteries slows the flow of blood to the brain. There are three ways this can lead to a stroke:

1. The plaque can severely narrow the arteries
2. A blood clot can become wedged in the artery
3. Plaque from the carotid arteries can break off and block a smaller artery in the brain

Carotid arterial blockages may result in the brain not receiving enough oxygen; this can cause death or permanent disability. There are specific risk factors for the development of carotid disease. These risk factors are the same as those that lead to development of coronary artery disease: high blood pressure, diabetes, high levels of “bad cholesterol”, smoking, family history of coronary or carotid artery disease and lack of exercise.

Carotid artery disease often has no symptoms. But a transient ischemic attack (TIA, sometimes called a “mini- stroke”) is a warning that you might soon have a stroke. These are temporary episodes of stroke –like symptoms, which may last a few minutes or a few hours. Symptoms of TIA (or stroke) include:

1. Weakness, paralysis, numbness or tingling on one side of your arm, leg or face
2. Loss of eyesight or blurry eyesight, even for a short time period
3. Sudden slurred speech

There are several tools for diagnosing carotid artery disease. Your doctor may be clued that carotid disease is developing by using a stethoscope during a normal checkup. But this method can produce false negatives, meaning you may have the disease even if your doctor does not detect it. Doppler ultrasound imaging uses sound waves to check blood flow and measure artery thickness and is the least expensive, noninvasive method of confirming the diagnosis. Magnetic Resonance Angiography uses magnetic fields to generate a picture of your arteries. Digital Subtraction Angiography, a way to x-ray the carotid artery has for years and continues to be the most accurate method of confirming the extent of disease present in the carotid arteries.

Treatment options for carotid artery disease include lifestyle changes, medication, surgery and endovascular angioplasty and stenting. Quitting smoking, lowering the amount of cholesterol and salt in your diet, exercising and losing weight help reduce the likelihood of developing peripheral arterial disease. There are also procedures to open your arteries. Vascular surgeons (specialists) have managed both the medical and surgical disorders related to peripheral vascular disease and have traditionally cared for those with carotid artery disease and thus are the physicians with the most experience in managing carotid disease.

If you have carotid artery disease or fear that you may have had symptoms related to carotid disease, it is vital that you seek care with your primary physician or vascular specialist. Since every case is unique, it is important that your physician is skilled in every option regarding the treatment of carotid disease – medical, surgical and endovascular.

Albert D. Sam II, MD is a board certified vascular surgeon with Vascular Associates of Baton Rouge and Total Vein Care.