Carotid Artery Disease

The carotid arteries are located on either side of your neck and carry blood to your brain. The common carotid artery divides into the internal and external carotid arteries in the middle of the neck. The external carotid artery delivers blood to the face and scalp, and the internal carotid artery delivers blood flow to the brain. The area where the internal and external carotid artery divides is particularly prone to develop atherosclerotic plaque. This plaque narrows the artery and can either completely obstruct flow to the brain or a piece of the plaque can break free and travel to the brain and cause a stroke. The greater the severity of the narrowing, the higher the risk of stroke.

SIGNS AND SYMPTOMS

There are a number of signs and symptoms that can come from carotid artery stenosis. They include:

  1. Numbness/weakness or loss of coordination of an arm and/or leg on one side of the body.
  2. Drooping on one side of the face or mouth.
  3. Change or loss of vision in one eye.
  4. Thick, garbled speech, or the inability to speak or understand speech.
  5. Episodes of memory loss.
  6. Loss of consciousness.
  7. Bruit or abnormal sound in carotid artery.

TREATMENT

Your doctor will discuss several different treatment methods for carotid artery stenosis. Typically, the treatment is based on the degree of stenosis or narrowing of the artery, the symptoms you are having and your overall medical condition. There are three major methods of treatment: medication, surgery or angioplasty and stenting.

1. Medication – Mild to moderate stenosis of the carotid arteries can be treated with medication alone. These medications reduce the risk of stroke and include Aspirin, Plavix or occasionally Warfarin (Coumadin). These agents make your blood less likely to clot and reduce your chances of stroke. Although these medications may be effective, if you have a significant narrowing of the carotid artery, surgery is the most effective treatment.

2. Surgery – Surgical repair is typically required when the narrowing of the carotid is severe. The operation is called a carotid endarterectomy. The surgeon makes an incision down the side of your neck and exposes the carotid artery. The artery is then clamped and opened. Often your surgeon will insert a “shunt” in the artery to maintain blood flow to that side of your brain while he works. The plaque that obstructs the artery is removed and the incision in the artery is closed.

Often the surgeon will close the incision in the artery with a “patch” that will reduce the chances of recurrent narrowing. Some patients need surgery on both the right and the left carotid arteries. One artery is repaired at a time, with a few weeks to a few months in between the surgeries.

3. Angioplasty and Stenting – A new method of treating carotid artery stenosis is balloon angioplasty and stenting. With this procedure your doctor will insert a catheter into an artery in your groin or arm and advance it through the narrowing in the artery in your neck. A special balloon catheter will be used to compress the plaque, thereby opening the artery. This area will be kept open with the placement of a stent (wire support or “bird cage”) over the catheter. The advantage of this technique is that it does not require an incision or deep anesthesia. However, it is a relatively new procedure and is considered experimental at this time. Currently, this procedure is performed under research protocol only.

Each of these methods of treatment has advantages and disadvantages; therefore, it is important to understand that the same therapy is not the best for all patients. Your doctor and the vascular team will determine which of the above treatments is best for you and will discuss this with you.