Vascular Disease

Carotid Artery Disease

The carotid arteries in the neck are the major suppliers of blood to the brain.  These arteries may become narrowed, thickened, and blocked due to atherosclerosis, also known as “hardening of the arteries”.  Severe blockage is associated with temporary or permanent brain damage caused by cutting off the blood supply to a part of the brain.

Stroke/Transient Ischemic Attack

As atherosclerosis worsens and more plaque collects along the inside walls of the artery, the chance that problems may occur increases.  If a piece of plaque breaks off (embolus), it can travel through the arteries to the brain and cause a blockage of blood flow.  Depending upon the size of the particle and where it ultimately travels, this may result in a stroke or transient ischemic attack (TIA) or “mini-stroke”.  If symptoms last longer than 24 hours, the episode is typically referred to as a stroke.

Stroke/TIA Signs and Symptoms

The classic signs and symptoms of a stroke or TIA may include loss of vision in one eye, difficulty with speech, numbness, weakness, paralysis of one side of the body or face, or problems with balance or coordination.

Diagnostic Testing

Detection of significant but silent carotid artery disease permits treatment of severe disease hopefully before a stroke occurs.  A carotid bruit (an abnormal murmur due to narrowing of the carotid artery which is heard with a stethoscope) or a difference in pulses between the two sides of the neck suggests an increased risk for carotid disease.  A carotid duplex scan is an ultrasound examination that visualizes the arteries and assesses the amount of blockage that is present.  A CT arteriogram (CTA)  is often useful to determine the exact amount of blockage present.  A CT scan or MRI of the brain can determine if any brain injury or previous stroke has occurred.

Medical Treatment

The usual measures to control risk factors for vascular disease are indicated for the treatment of carotid artery disease.  In addition, medications to decrease clot formation in the blood are frequently prescribed, such as aspirin, Plavix, or one of the newer blood thinning medications.

Surgical Repair

Direct treatment of the severely narrowed carotid artery is usually by carotid endarterectomy, a surgical procedure that involves opening the affected artery and removing the plaque.  This procedure is well established, provides long-lasting benefit and carries minimal risk in most patients. Carotid stenting in select patients may also be an option.  Hospital stay is usually one day.  Most patients experience minimal discomfort and are able to return to usual activities after a brief recovery period of seven to 14 days.