Carotid Artery Stenosis
Jacob McCleerey, OMS III and Bryan Kramer, MD
Carotid Artery Stenosis, also called carotid artery disease, is a narrowing of one or both of the blood vessels that run on both sides of the neck and delivers blood to the head and brain. Stenosis, or narrowing, of this vessel deprives the head and brain of blood and increases the likelihood of a stroke or transient ischemic attack (TIA).
The narrowing of the carotid artery is a similar mechanism seen in coronary artery disease and is most commonly due to atherosclerosis, or fatty cholesterol plaques, that build up and cause blockages in the vessels. Risk factors for the development of cardiovascular disease and carotid stenosis are advanced age, tobacco use, high blood pressure, and diabetes.
Carotid artery stenosis (CAS) is asymptomatic for most patients; however, some patients may complain of sudden, painless loss of vision that spontaneously recovers or numbness, tingling, or weakness in an extremity. These symptoms, whether loss of vision or weakness or numbness in an arm or leg, are always on one side of the body or the other- they are NEVER present in BOTH arms or legs. Lack of blood flow injures an area of the brain, and whatever area is injured affects the OPPOSITE SIDE OF THE BODY from the injured brain region. These symptoms are concerning for a stroke or Trans Isecmic Attack (TIA) and patients with these symptoms should seek medical attention right away. The sooner symptoms are treated the better the prognosis for the patient.
During a stroke, the brain loses its supply of oxygen due to a loss of blood flow. A TIA is similar to a stroke, although the loss of blood flow and oxygen to the brain is temporary and any loss of function gradually returns. CAS is the most common cause and risk factor for both stroke and TIA and often occurs when a part of the fatty plaque breaks off and gets stuck in a smaller vessel in the brain, blocking blood flow.
CAS is first treated with switching to a healthy diet and smoking cessation as well as medications that help control cholesterol and plaque formation. For patients that experience symptoms related to carotid stenosis and/or have a narrowing of the vessel greater than 70-80%, a surgical procedure known as a carotid endarterectomy (CEA) is preferred. Ideally this procedure would take place within 2 weeks of symptom onset.
During a CEA procedure, the surgeon makes an tiny incision along the front of the neck to gain access to the carotid artery. The surgeon then removes the plaque from the artery and sews the artery back up. In some cases, placing a carotid stent may be used as an alternative to a carotid endarterectomy. In this procedure, the surgeon inserts a catheter into the narrowed artery and inflates a balloon to widen the vessel, then a metal mesh stent is placed in the vessel in order to keep it open and decrease the chance of it narrowing again. Carotid surgery generally has a lower risk of causing a stroke during the procedure than stenting, so it is relatively rare to favor a stent over surgery for carotid disease.
CAS can be a life-threatening disease and patients diagnosed or who are at risk for this disease should visit a vascular surgeon. No other specialty has expertise in all three areas of treatment- medication and observation, angioplasty and stent placement, and carotid surgery. The main goal of treatment is preventing stroke and keeping people safe from brain injury, with procedures being the last resort if that is the safest option for the individual patient. If you are worried about carotid artery disease and stroke, the first step is to see a vascular surgeon and get a painless carotid ultrasound in their vascular lab.
Vascular Institute of the Rockies is here to help diagnose, treat and help you manage your carotid disease.
Contact us today for an appointment.