As a neurosurgeon, I see many people who have carotid artery disease. Quite a few of these patients had never heard about the condition until they were diagnosed with it.
Many people know about the dangers of blocked arteries and plaque buildup in the heart. But they may not realize that the carotid arteries in the neck can become blocked too — a condition called carotid stenosis — which can be equally dangerous.
That’s why I encourage everyone to learn about carotid stenosis. This information can help you avoid critical health problems and get the right care quickly if a problem does arise. Here’s what you should know.
1. Carotid stenosis is serious.
The carotid arteries carry blood to the front part of your brain. There are two of them, and you can feel them on each side of your lower neck, below the angle of your jaw.
In carotid stenosis, these important arteries narrow. This is usually caused by atherosclerosis, which is a buildup of fat, cholesterol, and other substances in the bloodstream. These materials can stick to the artery wall and, over time, create plaque. It’s this plaque that can lead to narrowing or a blockage in one or both arteries.
Narrowed or blocked carotid arteries are a major cause of stroke and transient ischemic attacks (TIAs) — also known as ministrokes — in the U.S. TIAs can progress into major strokes and they can also help predict the risk of a future stroke. We’ve found that someone who has had a TIA is 10 times more likely to suffer a major stroke than someone who hasn’t experienced a TIA.
During a stroke, the brain doesn’t get the blood supply it needs. Within minutes, tissue can begin to die. Stroke can cause issues ranging from loss of function to death.
2. It’s important to know if you’re at risk for carotid stenosis.
Several factors can contribute to an elevated risk of carotid stenosis:
- Family history of atherosclerosis
- Age, because the risk of atherosclerosis increases as we get older
- High levels of triglycerides and low-density lipoprotein (LDL), known as the bad cholesterol
- Smoking
- Hypertension (high blood pressure)
- Diabetes
- An unhealthy weight
- An inactive lifestyle
People who have coronary artery disease or peripheral arterial disease (narrowed or blocked arteries affecting the limbs) also have a higher risk of developing carotid stenosis.
3. You may not always know if your carotid arteries are blocked.
My patients often report that they were surprised to learn they had carotid stenosis. That makes sense, as the disease doesn’t always cause symptoms. However, dizziness, fainting, and blurred vision can be signs that the brain isn’t getting enough oxygen because the carotid arteries are blocked. Stroke and TIAs are the other symptoms of carotid stenosis, and it’s crucial to recognize when you might be having either of these potentially life-threatening events.
With TIAs, people have symptoms that can last anywhere from a few minutes to a few hours. These symptoms can occur alone or in combination:
- Sudden loss of vision or blurred vision, in one or both eyes
- Weakness or numbness in the face or limbs, often only on one side of the body
- Slurred speech, trouble talking, or difficulty understanding others
- Loss of coordination
- Dizziness or confusion
- Difficulty swallowing
- Sudden, severe headache with no known cause
The symptoms of a stroke are the same as those of a TIA. If you experience any of these symptoms, you need expert medical care immediately. I strongly recommend calling 911 so you can get treated as soon as possible. With strokes and TIAs, early treatment provides the best chance for full recovery.
4. There are several ways to determine if one or more carotid arteries are blocked.
When we check for carotid stenosis, we start with a thorough history and a physical exam. Sometimes we can detect a whooshing sound when listening to the carotid arteries with a stethoscope. This sound is called a bruit, and it can indicate carotid artery disease. However, not everyone whose carotid arteries are blocked has a bruit. Often, other tests are needed.
At Temple Health, we have a variety of advanced imaging tools we can use when diagnosing or ruling out carotid stenosis:
- Carotid ultrasound
- Carotid angiography
- Magnetic resonance angiography
- Computed tomography angiography
All of these tests are minimally invasive and give us a better view of the carotid arteries. They help us determine what’s going on and what kind of treatment plan a patient needs.
5. Carotid stenosis can sometimes be treated with medicines.
I regularly prescribe medication to my patients with carotid artery disease to help keep it under control. The most common of these drugs is aspirin. Clopidogrel (Plavix) and dipyridamole (Persantine) are two other common drugs. I prescribe these alone or along with aspirin to reduce the risk of stroke. Sometimes I prescribe warfarin (Coumadin) to thin the blood and reduce the risk of blood clots.
We also use other medications to address the underlying conditions that can contribute to carotid artery disease. If diabetes, high blood pressure, or high cholesterol are problems, we’ll use targeted drugs to help get them under control.
Lifestyle changes can also be powerful. I talk to all of my patients about getting at least 30 minutes of exercise most days. Eating a diet low in saturated fat, cholesterol, and sodium and maintaining a healthy weight can prevent carotid artery disease from progressing, too. And if you smoke, it’s never too late to stop. Stopping smoking has a powerful effect on reducing your risk of stroke and other cardiovascular events.
6. Medical procedures may be needed also.
For my patients who have more severe carotid stenosis, I often recommend surgery. It opens the artery and increases the blood flow to the brain. This can help prevent a future stroke.
Traditionally, carotid endarterectomy has been the surgical treatment for this condition. In this surgery, we make an incision in the neck at the site of the blockage. Then, we remove the plaque and stitch the artery back up. It’s a proven procedure, but there are minimally invasive options as well.
With carotid angioplasty and stenting, a small incision is made at the wrist or groin. From there, a catheter with a balloon is run up to the blockage. Then the balloon is inflated to flatten the plaque and widen the artery. Carotid angioplasty is combined with stenting. A catheter is used to place a small mesh tube in the artery once it is opened. The stent stays there and supports the artery, helping to keep it open.
Treatment for carotid stenosis can be complicated. That’s why you need a team of experts. The neurologists and neurosurgeons at Temple Health specialize in this type of care. We will work with you to determine the treatment plan that’s right for you.
Schedule an appointment at the Temple Neurosciences Center or call 800-TEMPLE-MED (800-836-7536) today.
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