Carotid Artery Disease

Carotid Artery Disease is a condition in which the carotid arteries become narrowed or blocked. When the arteries become narrowed, blood can’t reach the brain. This is one of the causes of stroke and the condition is called carotid stenosis.

Causes of Carotid Artery Disease:

Carotid Artery Disease is caused by atherosclerosis, a disease in which a plaque builds up inside the arteries. Arteries are blood vessels that carry oxygen-rich blood to the heart and other parts of the body. Plaque contains clumps of:
i. Cholesterol
ii. Fat
iii. Cellular waste
iv. Protein
v. Calcium

Carotid artery disease is associated with smoking, high blood pressure, high cholesterol levels, and poorly controlled diabetes. They may cause damage to the inner walls of the arteries. As the plaque grows, it narrows the artery area from where the blood flows and this increases pressure within the artery and blood turbulence, which leads to more arterial damage and plaque formation.

Symptoms of carotid artery disease: -

Carotid artery disease has no symptoms and can vary person to person as some can have symptoms that are either transient (TIA or transient ischemic attack) or permanent: -

Weakness or paralysis or inability to move a body parts
Inability to understand or produce speech (Aphasia)
Inability to speak or articulate clearly
Inability to interpret sensations and hence to recognize things (Agnosia)
Blindness or visual changes in eyes
Difficulties in swallowing
Lack of control over bladder (Urinary incontinence)
Emotion and mood changes
Loss of memory

Test to diagnose carotid artery disease:

Carotid Ultrasound (Standard or Doppler):

This non-invasive, painless screening test uses high-frequency sound waves to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked. A Doppler ultrasound shows the movement of blood through the blood vessels. Ultrasound imaging does not use X-rays.

Magnetic Resonance Angiography (MRA):

This imaging technique uses a powerful magnet to gather accurate information about the brain and arteries. Then a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain.

Computerized Tomography Angiography (CTA):

More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross-sectional images of the carotid arteries. Images of the brain can be collected as well. With this imaging test, the scan may reveal areas of damage to the brain. The CT scan uses a low level of radiation.

Cerebral Angiography (Carotid Angiogram):

This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real-time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications.

Carotid Artery Treatment:

The goal in treating carotid artery disease is to prevent stroke. Specific treatments depend on the extent of blockage in your carotid arteries.

Carotid artery treatment depends upon on the extent of blockage in your arteries, preventing stroke is the goal. If the blockage is mild or moderate the doctor will suggest: -

Lifestyle Modification: The doctor will recommend quit smoking, eating healthy, losing weight, reducing salt intake and exercising regularly.
Medication to control blood pressure and cholesterol levels: Doctor may recommend taking aspirin or other blood thinning medication to prevent blood clots.

If the blockage is severe or a patient already has a TIA (transient ischemic attack), than surgery is performed to remove the blockage from the arteries.

Carotid endarterectomy: Carotid artery endarterectomy is the surgical procedure in which a vascular surgeon surgically opens the carotid artery and removes the plaque from the artery to reduce the risk of future strokes.
Carotid angioplasty and stenting: Angioplasty and stenting are usually performed using local anaesthesia and includes the use of uniquely designed devices that can limit debris from travelling to the brain while the procedure is being performed. In angioplasty, a balloon catheter is guided to the area of the blockage or narrowing. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls to improve blood flow. A medication such as heparin may be given during the procedure to reduce the risk of blood clots.