Introduction

Carotid artery disease results when the carotid arteries become blocked, impairing their ability to transport blood efficiently. The carotid arteries carry blood from your heart to your head and brain. Carotid artery disease can develop over time from plaque buildup. This can lead to a mini-stroke, stroke, or death. Carotid artery disease may be treated with lifestyle changes, medications, interventional procedures, and surgery.

Anatomy

The heart pumps blood into several large arteries that branch out and become smaller as they travel throughout your body. Arteries are blood vessels that carry oxygenated blood away from your heart. Veins are vessels that carry deoxygenated blood from your body and lungs back to your heart.

The aorta is the largest blood vessel in your body. The aorta carries all the blood that is pumped out of your heart and branches progressively to distribute blood to all of the organs and throughout the body. The carotid arteries branch off the aorta and deliver blood to your head and brain. Coronary arteries branch from the aorta, which supply the heart with oxygen, blood, and nutrients to keep it healthy.

Causes

Carotid artery disease occurs when the carotid arteries become narrow or blocked. This can reduce or obstruct the blood flow to the head and brain. The main cause of narrowing or blockage is plaque, calcium, and fibrous tissue buildup. The arteries may harden and not be able to transport blood as efficiently, in a process called atherosclerosis.

A narrowed artery can obstruct the flow of blood to the brain and lead to a stroke. Plaque build-up can lead to a stroke if a piece of the plaque breaks off, travels to the brain, and blocks a smaller artery in the brain. A blood clot can reduce or block the flow of blood to your brain causing a stroke.

Symptoms

Carotid artery disease may not cause symptoms in the early stages. The warning signs of a stroke may indicate that there is a blockage in the carotid arteries. You may experience a transient ischemic attack (TIA or “mini-stroke”). Symptoms of a TIA usually last a few minutes to an hour.

You should contact your doctor immediately if you suspect that you are experiencing a TIA. A TIA is a warning sign that you may develop a stroke. If your symptoms last longer than 24 hours, you may have experienced a stroke.

Diagnosis

A doctor can diagnose carotid artery disease by reviewing your medical history and conducting a physical examination and some cardiovascular tests. Your doctor will take your blood pressure and listen to the sound of your blood moving through your carotid arteries.

A carotid duplex ultrasound can detect most cases of carotid artery disease. To conduct the test, your doctor will simply move a small device over your carotid arteries. The device transmits sound waves that compose an image of your carotid arteries. If the carotid duplex ultrasound does not provide enough information, additional tests may be performed.

Magnetic resonance angiography (MRA) produces extremely detailed views of the blood vessels. Computed tomography (CT) and computed tomography angiography (CTA) produce images in sections that make up a whole picture of your brain or arteries. These tests are used to identify areas of poor blood flow and arterial narrowing. A dye and X-ray are used to show an image of the blood vessels with an angiography.

Treatment

The treatment of carotid artery disease depends upon the severity of your condition and your symptoms. Carotid artery disease may be treated with lifestyle changes, medications, interventional procedures, and surgery. Lifestyle changes may involve attaining and maintaining a healthy weight, blood pressure, cholesterol level, and blood sugar level. It can be helpful to exercise regularly and eat a diet low in salt, saturated fats, cholesterol, and trans fats. It is very important to quit smoking.

Your doctor may prescribe medications to prevent your blood from clotting and to help prevent a stroke. A carotid angioplasty is an interventional technique that involves inserting a catheter into the artery and using it to open the narrowed area in the artery. In some cases, a stent may be inserted to help keep the artery open.

Surgery may be used to treat carotid artery disease. A carotid endarterectomy is a surgical technique that is used to remove plaque from an artery. A carotid endarterectomy can have long-lasting results.

Prevention

You may prevent carotid artery disease by reducing the risk factors that you have control over including your weight, blood pressure, diabetes, cholesterol, activity level, and smoking. It can be helpful to exercise regularly and eat a well-balanced diet. You should attend all of your doctor appointments and receive regular physicals.

Am I at Risk

Risk factors may increase your likelihood of developing carotid artery disease, although some people that develop the condition do not have any risk factors.

Risk factors for carotid artery disease:

• Advancing age
• Family history
• Cigarette smoking
• Obesity
• Diabetes
• High blood pressure
• High cholesterol, particularly high LDL, and high triglycerides\
• People that are physically inactive
• In rare cases, carotid aneurysm disease and fibromuscular dysplasia

Complications

Carotid artery disease can cause a TIA or stroke and lead to death. You should contact your doctor immediately if you suspect that you are experiencing a TIA. You should call an ambulance if you suspect that you are having a stroke.