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Carotid artery disease

Definition


Disease: Carotid artery disease Carotid artery disease
Category: Cardiovascular diseases

Disease Definition:

The pair of blood vessels that deliver blood to the brain and head are called carotid arteries. When fatty deposits called plaques clog the carotid arteries, carotid artery disease occurs. A person’s risk of stroke is increased and the blood supply to the brain is blocked by the buildup of plaques in these arteries.

 

The first outward clue that one has the condition may be a stroke or transient ischemic attack (TIA), which is also called a ministroke, because carotid artery disease develops slowly and often goes unnoticed.

 

A combination of lifestyle changes, medications and in some cases, surgery or a stenting procedure are usually involved in treatment of carotid artery disease.
 

Work Group:


Symptoms, Causes

Symptoms:

Carotid artery disease often doesn't produce any signs or symptoms in its early stages. Until it's serious enough to deprive the brain of blood, the patient and his doctor may not know he/she has carotid artery disease.

 

The patient may develop signs and symptoms of a stroke or TIA, which is an early warning sign of a future stroke, if that happens. Some of the signs and symptoms may be:

 

  • Sudden blindness in one eye
  • Sudden numbness or weakness involving the leg,  arm  or face, typically on one side of the body
  • Slurred or garbled speech or difficulty understanding others
  • A person should seek urgent medical attention when experiencing any of these symptoms as he/she may be having a stroke.

 

When having these signs and symptoms, the person should tell the doctor right away, even if they last only a short while, usually less than an hour but, technically, anything less than 24 hours, and then one feels normal. The temporary shortage of blood to the brain known as a transient ischemic attack (TIS) is what this patient may have experienced. TIA shouldn't be ignored as it is an important sign that the person is at high risk of having a full-blown stroke.

 

When someone has risk factors for carotid artery disease, he/she should talk to a doctor. To see what shape the arteries of the patient are in, the doctor may do some tests. To protect the patient from stroke, aggressive management of his/her risk factors may be recommended, even if this patient doesn’t have any signs or symptoms.

 

When experiencing signs or symptoms of a transient ischemic attack or stroke such as loss of vision, slurred speech or numbness, a person should seek emergency care. Just because they may go away on their own doesn't mean that they can be ignored. The chances that carotid artery disease will be detected and treated before a disabling stroke occurs may increase by seeing a doctor early.

 

The patient should make sure that his/her family and close friends understand that it's critical to act fast in the event of a possible stroke and know the signs and symptoms of stroke.
 

Causes:

Healthy and normal carotid arteries are just like any other artery in the sense that they are flexible and smooth and they provide a clear pathway for blood flow. A person is likely to feel his/her carotid artery pulse when placing a finger under his/her jawbone, on either side of Adam's apple. Carotid arteries carry oxygen- and nutrient-rich blood to the cerebral cortex and other vital brain structures that are responsible for the day-to-day functioning.

 

However, due to a gradual accumulation of plaques, a process called atherosclerosis, the carotid arteries can become stiff and narrow over time. Calcium, fibrous tissue, clumps of cholesterol and other cellular debris that gather at microscopic injury sites within the artery form plaques. Doctors label the case as carotid artery disease when a lot of these plaques accumulate, narrowing the carotid artery and substantially restricting blood flow.

 

The risk of injury, buildup of plaques and disease are increased by these factors that stress the arteries:

Smoking:

Increasing blood pressure and heart rate, nicotine can irritate the inner lining of the arteries.

Aging:

The arteries become less elastic and more prone to injury with age.

Abnormal blood-fat levels:

The accumulation of plaques is encouraged by high levels of triglycerides, a blood fat, and high levels of low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol.

High blood pressure:

In the case of carotid artery disease, high blood pressure is an important risk factor. Arteries can weaken and become more vulnerable to damage because of excess pressure on the walls of these arteries.

Heredity:

The risk of developing conditions such as coronary artery disease or atherosclerosis increases in the case of having a family history of these conditions.

Obesity:

A person’s chances of diabetes, high blood pressure and atherosclerosis can be increased by carrying excess pounds.

Diabetes:

Placing the patient at greater risk of atherosclerosis and high blood pressure, diabetes affects the ability of a person’s to process fats efficiently as well as the ability to handle glucose appropriately.

Physical inactivity:

A number of conditions that include obesity, diabetes and high blood pressure, can be contributed to by lack of exercise.

 

Creating even greater risk than if they occur alone, these risk factors often occur together.
 

Complications

Complications:

Stroke is the most serious complication of carotid artery disease. Carotid artery disease can increase someone’s risk of stroke in different ways:

Blood clot blockage:

Some plaques may crack and form irregular surfaces on the artery wall. So the body reacts as if to an injury and sends platelets, which are blood cells that help the clotting process, to the area when this happens. Causing a stroke, a large blood clot may develop in this way and block or slow the flow of blood through a carotid or cerebral artery.  

Reduced blood flow:

Atherosclerosis may make a carotid artery so narrowed that not enough blood is able to reach portions of the brain.

Ruptured plaque:

A piece of a plaque may break off and flow to smaller arteries in the brain (cerebral arteries). Creating a blockage that cuts off blood supply to the area of the brain that the cerebral artery serves (stroke), this fragment may get stuck in one of these smaller arteries.

 

In severe cases, a stroke can be fatal. And in general, it can leave the patient with permanent brain damage and muscle weakness.
 

Treatments:

Preventing stroke is the goal of treating carotid artery. How narrow the arteries have become is the thing that determines the method of treatment:

 

In mild to moderate cases, to prevent stroke, lifestyle changes and medications may be sufficient.
If blockage is severe or if the patient has already had a TIA or stroke, a stenting procedure or surgery may be necessary.

 

LIFESTYLE CHANGES:

The important steps in slowing the progression of atherosclerosis and reducing the stress on the arteries are exercising regularly, eating healthy foods, losing weight and quitting smoking. Lowering the sodium content of food may help as well.

 

As prescribed by the doctor, it's very important to manage any chronic conditions the patient may have as well. Staying at or under the blood pressure goal is important when having high blood pressure. In the same way, controlling the blood sugar levels when having diabetes, or making the cholesterol low when having high cholesterol levels are important.

 

MEDICATIONS:

To avoid the formation of dangerous blood clots, the patient may be asked to take a daily aspirin or another blood-thinning medication. Medications to control the blood pressure such as calcium channel blockers or angiotensin-converting enzyme (ACE) inhibitors, or a statin medication to lower the cholesterol of the patient may be recommended as well.

 

PROCEDURES:

It's best to open up the artery and remove the blockage if narrowing in a carotid artery is severe, and especially if the patient has already experienced a TIA or stroke. This could be done in two ways:

Carotid endarterectomy:

The most common treatment for severe carotid artery disease is this surgical procedure. It could be performed under local or general anesthesia. The affected carotid artery is opened and the plaques are removed after making an incision along the front of the patient's neck. Stitches or a graft could be used to repair the artery. In most otherwise healthy people the surgery is low risk, helps prevent strokes and has lasting benefit, as studies have proved.

Carotid angioplasty and stenting:

When the patient has other health conditions that make surgery too risky, or when the location of the narrowing or blockage is too difficult for the surgeon to access directly, a carotid endarterectomy isn't recommended. So a procedure called carotid angioplasty and stenting may be recommended in a case like that. A tiny balloon is threaded by catheter to the area where the carotid artery is clogged while the patient is under local anesthesia. The balloon is inflated to widen the artery, and a small wire-mesh coil called a stent is inserted to keep the artery from narrowing again. The durability and long-term ability to prevent stroke in this procedure are still under investigation, as the procedure is relatively new.
 

Prognosis:

Not available

Expert's opinion

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