Stroke is the fifth leading cause of death and the number one cause of disability in the United States, according to the American Stroke Association. Carotid artery stenosis is a major underlying cause of stroke, impacting up to 5% of the population.
Your carotid arteries are the two main arteries that carry blood from your heart, up through your neck, and into your brain. Healthy carotid arteries are smooth and unobstructed, allowing blood to flow freely to the brain. They provide oxygen, glucose (sugar), and other nutrients your brain cells need to function optimally.
As you age, the carotid arteries may build up plaque, fatty deposits made up of mostly fat and cholesterol. This plaque narrows the insides of the arteries, making them stiff. The build-up of plaque is commonly referred to as “hardening of the arteries” or atherosclerosis.
Carotid artery disease results when the carotid arteries become narrow or obstructed, which increases the risk of the plaque traveling to the brain and causing a stroke. If you are at risk of a stroke due to carotid artery stenosis, there are several treatments available that can help lower your risk.
Causes and Risk Factors of Carotid Artery Stenosis
Carotid artery stenosis leads to atherosclerosis, increasing your risk of a Transient Ischemic Attack (TIA), the most common cause of stroke.
Risk factors of carotid artery stenosis and stroke include:
- Age above 65 years old
- Diabetes
- High cholesterol
- High blood pressure (hypertension)
- Smoking
- Coronary artery disease (heart disease)
- Obesity
- Lack of exercise
Early Symptoms and Warning Signs
An early symptom of carotid stenosis is a TIA or mini-stroke that can resolve in less than 24 hours with no long-term effects. TIAs are strong predictors of a future stroke when blood flow becomes completely blocked from the brain.
Others may notice a symptom known as amaurosis fugax, a temporary loss of vision that manifests as curtain shade blocking vision in the affected eye. This condition is caused by a small piece of plaque breaking off from the carotid artery and traveling to the retinal artery, which supplies the eye with blood.
But, sometimes plaque buildup can occur over months to years in the artery with no symptoms until one day, the plaque breaks off and leads to a stroke, which means carotid stenosis can be dangerous. Therefore, it is important to know the symptoms of a stroke, including:
- Numbness on one side of your body
- Weakness, paralysis, or loss of coordination on one side of your body
- Drooping on one side of your face or mouth
- Blindness or loss of part of the vision in one eye that typically is described as a shade being drawn over an eye
- Loss of speech or garbled speech
- The inability to write or understand writing
- Episodes of memory loss
If you or a loved one experiences any of these symptoms, you must call 911 and visit your closest emergency room for immediate medical attention. Because the plaque buildup occurs with no symptoms, this is the reason why screening for carotid stenosis is so important.
How Carotid Artery Stenosis is Diagnosed
As there are no outward signs of carotid artery stenosis, a medical evaluation will be required for a diagnosis. Diagnosing carotid artery stenosis is typically noninvasive and painless. Typically, a diagnosis will start with a physical exam and evaluation of your medical history. Your doctor will listen to the artery on your neck with a stethoscope to try to hear a noise called a bruit, which is the whistling sound the blood makes when it passes through a blocked artery.
Depending on your risk factors, your doctor may recommend a noninvasive test called a carotid artery ultrasound, which will image the carotid arteries and determine if and how much blockage is inside.
Other tests for diagnosing a blocked carotid artery include:
- MRI scan: This procedure uses magnets and a computer to make detailed images of your organs and internal structures.
- Magnetic Resonance Angiography (MRA): This procedure also uses magnets and a contrast dye to examine the blood vessels and help identify those that might be blocked.
- Computed tomography angiography (CTA): This test uses X-rays and contrast dye to take pictures of blood vessels and tissues.
- Angiography or arteriogram: This procedure involves inserting a needle into an artery and injecting a special dye to allow your doctor to see detailed pictures of the inside of your arteries.
The type of test you need to evaluate the condition of your carotid artery and risk factors for stroke will be determined by your vascular surgeon.
Treatment Methods for Carotid Artery Stenosis
Empire Vein and Vascular Specialists offer state-of-the-art carotid artery stenosis treatments. One of these is a novel technique known as TransCarotid Artery Revascularization (TCAR) that reduces the risk of stroke for high-risk patients. TCAR minimizes surgery risks by keeping potential stroke-causing plaque away from the brain using a breakthrough proprietary device.
The procedure takes less than half the time of a carotid endarterectomy and does not require general anesthesia, which limits stress on the heart and significantly reduces the risk of having a stroke or heart attack during the procedure. Patients who undergo the TCAR procedure recover quickly and return to their day-to-day activities the next day, with less pain, smaller incisions, and a reduced risk of future strokes.
The board-certified vascular surgeons at Empire Vein and Vascular Specialists have performed more than 500 TCAR procedures, more TCAR procedures than any other vascular practice in California.
Another treatment option is a carotid endarterectomy, where plaque is removed from the artery and the artery is repaired. Most patients are discharged the next morning and can resume normal activities the next day, with limited heavy exercise for a week.
A third option is a carotid stent which is a small mesh tube placed inside the artery to help keep it open and allow for the flow of blood to the brain. This is a minimally invasive procedure that can help reduce the risk of stroke.
Empire Vein and Vascular surgeons are experienced in all three of these procedures and will recommend which option is right for you,
Strategies for Carotid Stenosis Prevention
A healthy lifestyle can help prevent or slow the progression of carotid artery disease. Prevention measures include a diet low in saturated fat, maintaining a healthy weight, exercising regularly, not smoking, and managing stress. Managing chronic conditions such as diabetes, high blood pressure, or high cholesterol can also help lower your risk of complications from carotid artery disease.
If you need even more support to help prevent or manage carotid artery stenosis and lower your risk of stroke, the board-certified physicians at Empire Vein and Vascular Specialists are the leading experts in Riverside and San Bernardino counties and the Coachella Valley in vein and vascular issues. Unlike most other vascular surgical groups, we are uniquely trained and experienced to offer all forms of diagnosis and therapy. Call 1-800-VARICOSE (1-800-827-4267) or book an appointment online to get started.
FAQs
Should I be checked for carotid stenosis (blockage)?
If you are concerned about carotid stenosis or your risk of stroke, start by discussing your concerns with your physician, who will take a detailed history and exam. If you have risk factors for carotid disease, they can order a noninvasive test known as a carotid ultrasound to detect plaque buildup in the artery.
I have been told that I have plaque buildup in my carotid artery. Is this an emergency? Do I need surgery?
No, surgery is not required for all patients who have carotid stenosis, and even if they do, it is rarely an emergency. If you have carotid stenosis, you will likely be referred to a vascular surgeon, a specialist in the diagnosis and treatment of this condition. Only patients with a significant amount of plaque buildup (usually 75% or greater) or recent symptoms of a mini-stroke, known as a TIA (Transient Ischemic Attack) or a stroke, will be recommended for surgery.
I need carotid surgery. What type of doctor should I see?
A board-certified vascular surgeon is uniquely qualified to treat carotid artery stenosis. They have the experience and access to multiple treatment options, including surgery (carotid endarterectomy) and minimally invasive options, such as carotid stent and TCAR. A vascular surgeon will evaluate your health history and recommend the best treatment for you.
I have heard a lot about TCAR. What is so special about it?
Trans carotid artery revascularization (TCAR) is an excellent minimally invasive option for the treatment of carotid artery stenosis. The procedure avoids the risks of general anesthesia, lowering the risk of stroke, which can happen with other procedures.
A TCAR is performed by a vascular surgeon at the hospital and takes about an hour to complete. It involves making a very small incision at the base of the neck. Patients are usually discharged in 24 hours and have a quick recovery. It is quickly becoming the preferred method of treatment for carotid disease.
On-going follow-up and surveillance after the procedure is important for long-term success. Your vascular surgery team will arrange for follow-up ultrasounds every six months to monitor the stent and look for signs of blockage recurrence.
I have been diagnosed with carotid stenosis. Why should I choose Empire Vein and Vascular Specialists?
At EVVS, we collectively have over 30 years of experience in treating carotid artery disease and have performed more than 500 procedures for carotid stenosis. In addition, we are one of the nationwide leaders in the TCAR minimally invasive procedure for carotid artery stenosis.
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