Carotid artery disease

Carotid artery disease occurs when plaque builds up and clogs the arteries that deliver blood to your head and brain, known as your carotid arteries. The buildup is caused by a condition called atherosclerosis, or the collection of fatty substances and cholesterol that causes the arteries to harden, restricting blood flow. For patients with carotid artery disease, the real concern is the rupturing of built-up plaque. The plaque that builds up in the carotid artery is under pressure and too much can cause it to burst. If this happens, pieces of the plaque can break off and get carried away with the blood flowing to the brain, which could lead to a stroke.

When it comes to the treatment of carotid artery disease, we take a very careful, meticulous approach. First, we perform extensive diagnostic tests to get a thorough understanding of the severity of your atherosclerosis. Depending on the extent of your condition, we may advise you on simple lifestyle modifications you can make to improve your condition, put you on medication and/or recommend a surgical procedure.

We only perform surgery when necessary because while plaque removal procedures are done to prevent strokes, they also carry a high risk of causing them. In situations where a procedure is warranted, we believe in exploring minimally invasive options first and taking all steps available to reduce the risk of stroke during the procedure. Our careful approach, as well as the skill of our surgeons, is proven by the low stroke rates we maintain. Strokes occur in less than 1 percent of plaque removal procedures performed by our surgeons, which is well below the national average of 3 percent. We consistently provide patients with the highest level of safe, quality care.

Carotid artery disease is often asymptomatic, meaning patients have no symptoms at all. However, in some cases you may experience:

• Weakness
• Headache
• Dizziness
• Blurred or double vision
• Loss of balance
• Confusion or memory loss
• Difficulty speaking

If you experience any of the above symptoms, have atherosclerosis, or are at increased risk, you should ask your primary care physician to screen you for the condition.

Atherosclerosis is the buildup of plaque and fatty substances in the arteries, which causes them to harden and narrow. The condition can lead to carotid artery disease. Therefore, if you have atherosclerosis, it is important to monitor the condition closely.

The risk factors for carotid artery disease include:

• Diabetes
• Smoking
• High cholesterol
• High blood pressure
• Being middle-aged or older (risk increases with age)
• A family history of coronary artery disease, carotid disease, vascular disease or atherosclerosis 

Carotid artery disease is very common, affecting up to 3 percent of patients aged 65 and older, according to the Society for Vascular Surgery.

The most severe complication associated with carotid artery disease is the risk of a stroke, which can cause permanent brain damage, and even death. There are three scenarios that could cause a stroke to occur:

• Your carotid arteries become so compressed from built-up plaque that they restrict blood flow to the brain
• A piece of plaque breaks off and wedges into an artery in the brain, resulting in a blockage that obstructs blood flow
• A blood clot forms in the carotid artery, blocking blood from reaching the brain

Another complication associated with carotid artery disease is a transient ischemic attack, a stroke-like attack that occurs when a clot briefly blocks a blood vessel to the brain. Unlike strokes, TIA attacks do not cause permanent or long-lasting damage, but they are a warning sign of an impending stroke.

The diagnostic process might include carotid duplex scan (otherwise known as an ultrasound), which is a non-invasive test that uses sound waves to create images of the arteries. This might be done in conjunction with other imaging techniques to get a full, accurate picture of your carotid arteries.

In cases where your condition is categorized as mild or moderate, meaning that the blood vessel’s narrowing is less than 80 percent, our treatment may consist solely of lifestyle modifications, such as exercising regularly, controlling blood sugar and cholestrol, quitting smoking and close monitoring of the arteries. In situations where a procedure is warranted, we believe in exploring minimally invasive options first. In some instances, we may forego general anesthesia in place of local anesthesia, which is better tolerated by patients.

Most often, we treat this condition with a carotid endarterectomy, which involves scraping the plaque out of the artery to restore blood flow. We do this through a small incision in the neck, which carries a recovery period of approximately one week. During this time, you will have sutures in place where the incision was made and may experience some soreness.

Other times, a minimally invasive approach may be necessary, such as an angioplasty, which uses a tiny balloon to open up the artery. Minimally invasive procedures are associated with short, relatively painless recovery periods, and many patients can leave the hospital that same day. 

When treating carotid artery disease, we may prescribe certain medications to manage risk factors, such as high blood pressure or cholesterol. We may also prescribe medication to reduce the risk of blood clots, such as a blood thinner. 

Stroke is the fifth leading cause of death in the United States. With ongoing care and testing to identify potential complications, carotid artery disease is manageable—especially when identified early. Research shows that the risk of stroke decreases significantly with the right balance of medication and lifestyle adjustments.

In addition to making changes to your lifestyle, regular checkups with your doctor are important. Paving the path to a healthier future takes teamwork, so we’ll work closely with you every step of the way to treat and manage your condition.