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Controllable Risk Factors – Carotid Artery Disease

Carotid artery disease (also called carotid artery stenosis) is the narrowing of the carotid arteries, the two main blood vessels in the neck that supply blood to the brain. Age, unhealthy lifestyle and not effectively managing stroke risk factors such as high cholesterol can lead to carotid artery disease. Plaque, often caused by cholesterol deposits, and other fatty substances can lead to the narrowing and – in some cases – complete blockage of an artery. Narrowed and blocked arteries can lead to stroke.

What are the symptoms?

There are often no symptoms of carotid artery disease. A person may not know they have it until they experience a TIA or stroke. It is important to discuss any stroke symptoms you experience with a healthcare professional, because they can conduct tests to diagnose carotid artery disease.

How is carotid artery disease diagnosed?

In most cases, the disease can be detected during a normal checkup with a healthcare professional, who might order the following tests:

History and physical exam: A healthcare professional may use a stethoscope to listen for a rushing sound, called a bruit (pronounced "brew-ee"), in a carotid artery. This tactic is not guaranteed to identify the disease. Some low-risk blockages can make a significant sound but high-risk blockages can be soundless.

Doppler ultrasound imaging: This painless, noninvasive test is conducted by sending sound waves above the range of human hearing into the neck. Echoes bounce off the moving blood and the tissue in the artery and be formed into an image.

Oculoplethysmography (OPG): This procedure measures the pulsation of the arteries in the back of the eye. It is used as an indirect check for blockages in the carotid arteries.

Computed tomography (CT) Scan: This test produces a series of cross-sectional X-rays of the head and brain. It cannot detect carotid artery disease but may be ordered to investigate other possible causes of stroke symptoms.

Arteriography and Digital Subtraction Angiography (DSA): Arteriography is an X-ray of the carotid artery taken when a special dye is injected into another artery in the leg or arm. DSA is also an X-ray of the carotid artery. It is similar to arteriography except that less dye is used. These invasive procedures carry their own small risk of causing a stroke.

Magnetic Resonance Angiography (MRA): This technique is more accurate than ultrasound, yet avoids the risks associated with X-rays and dye injection. An MRA is a type of magnetic resonance image (MRI) that uses special software to create an image of the arteries in the brain.

How is carotid artery disease treated?

This disease must be treated by a healthcare professional. Treatments may include medication, adopting a healthier lifestyle (eg, more exercise, better diet) and surgery, such as carotid endarterectomy.

What is a carotid endarterectomy?

Carotid endarterectomy is a surgical procedure in which a healthcare professional removes fatty deposits from the carotid arteries. While atherosclerosis and high cholesterol can often be managed with drug treatment, surgery is another option to help prevent stroke. Carotid endarterectomy is the most common surgery for removing fatty deposits. It can reduce stroke risk by as much as 55 percent.

Carotid endarterectomies can help prevent stroke in patients who have already experienced a stroke, have stroke symptoms or severe atherosclerosis (stenosis of 60 percent to 99 percent).

What other surgery can help with carotid artery disease?

Arterial bypass surgery does not help prevent stroke, but can re-establish blood flow when a carotid artery is blocked. Surgeons make a hole in the cranium and connect an artery serving the face or head to an artery serving the brain.


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