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Carotid Artery Disease

Carotid Artery Stenosis Treatment

The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health provides 24/7 treatment for carotid artery disease and strokes. Our board-certified neurologists, neurosurgeons, and professional support staff effectively treat carotid artery disease and/or strokes with advanced, state-of-the art medical interventions. By seeking prompt medical attention for carotid artery disease or a stroke, you can potentially reverse the damage these diseases can cause.

Interested in learning more about our Stroke Center? Contact us to request an appointment or take a tour.

What Are the Carotid Arteries?

The carotid arteries supply blood mainly to the large, front part of the brain, which controls thinking, speech, personality, and sensory and motor functions. These two large blood vessels, called the common carotid arteries, are located on each side of your neck. They carry oxygenated blood up to the head and brain. You can feel your carotid arteries by gently pressing on your neck on either side, right under the angle of your jawline; similar to how you would check your pulse.

The carotid arteries each divide into internal and external arteries, both of which have a separate but related function. The internal carotid arteries are responsible for supplying oxygen-rich blood to the brain, while the external carotid arteries supply blood to your face, scalp, and neck.

What Is Carotid Artery Disease?

Carotid artery disease, also called cerebrovascular disease or carotid artery stenosis, affects the 2 large blood vessels leading to the brain. A waxy, fatty substance called plaque builds up in the 2 common carotid arteries, and this inhibits blood flow to the brain. If blood supply to the brain is even partially cut off, it often causes a stroke, which is a medical emergency.

Usually, carotid artery disease is caused by atherosclerosis, which is a buildup of cholesterol, fat, and other substances traveling through the blood vessels. As these substances begin to accumulate, they form what is called arterial plaque, which is made of cholesterol, calcium, cellular waste products, and fibrous tissue. The process of plaque buildup is called atherosclerosis. Over time, plaque causes narrowing or blockage of the arteries. In carotid artery disease, the arteries are narrowed or clogged, leaving the individual at risk of stroke, if it is left undiagnosed and/or untreated. If the carotid arteries become narrowed from this plaque buildup, it increases the risk of a stroke.

What Is a Stroke?

Strokes are similar to heart attacks, in that blood flow is cut off to the brain. When the carotid arteries are clogged, blood cannot effectively reach the brain. Brain cell death occurs within minutes of the oxygen deprivation, and this causes irreversible, permanent damage. For this reason, it is extremely important to treat carotid artery disease as soon as it is diagnosed, and as aggressively as possible. Unfortunately, many individuals with carotid artery disease are asymptomatic, and the first symptom is a mini stroke or stroke.

Strokes can occur if:

  • The carotid arteries become extremely narrowed

  • The carotid arteries rupture

  • A piece of plaque breaks off and travels through the blood to the brain, creating a blockage

Risk Factors for Carotid Artery Disease

  • Hypertension (high blood pressure): A healthy blood pressure reading is around 120/80, and blood pressure consistently at or above 140/90 is considered high.

  • Unhealthy cholesterol levels: A person with high LDL (“bad”) cholesterol or low HDL (“good”) cholesterol has a higher risk of carotid artery disease.

  • Smoking: Tobacco use, particularly smoking cigarettes, damages and tightens the blood vessels, which in turn can elevate cholesterol levels and raise blood pressure. Smoking can also inhibit how much oxygen reaches the body’s tissues.

  • Diabetes: People who have diabetes are 4 times as likely to have carotid artery disease compared to those who do not.

  • Family history of atherosclerosis: Those who have no other risk factors may be prone to developing carotid artery disease because of a family history.

  • Age: Older adults are at greater risk for atherosclerosis, a process which begins in youth and progresses over many decades before diseases develop.

  • Sedentary lifestyle: Lack of physical activity can worsen other risk factors for carotid artery disease.

  • Poor diet: Eating a diet high in saturated or trans fats, cholesterol, salt, or sugar can exacerbate other carotid artery disease risk factors.

Symptoms of Carotid Artery Disease

Many who have carotid artery disease remain undiagnosed until they have a stroke, but there are warning signs of carotid artery disease you should be mindful of if you have risk factors. The most common first signs of carotid artery disease are transient ischemic attacks (mini strokes) or a stroke. Many who experience a mini stroke will eventually have another, or a full-blown stroke.

Transient Ischemic Attack (TIA), or Mini Strokes

TIAs are an important warning sign of a future stroke. These temporary episodes include symptoms such as headaches, dizziness, confusion, sudden paralysis, confusion, and tingling that may last from a few minutes to several hours. Often, symptoms go away after 24 hours and damage is minimal. However, if you or someone you know is having a TIA episode, it is important to seek emergency medical attention for diagnosis and treatment.

Strokes

Symptoms for strokes are, in fact, the same as a mini stroke, only the outcome of a stroke is different from a mini stroke. Many who suffer a stroke will have permanent brain damage and disabilities such as vision or speech difficulties and partial paralysis. As many as 17% of those who have a stroke die from the complications. Strokes are the 3rd leading cause of death and primary cause of disability in adults.

To spot a stroke, remember the mnemonic “FAST” – facial drooping, arm weakness, speech difficulties, and time. “Time” is a reminder that you must act fast to get to the hospital and receive treatment right away.

If you suspect you or someone you know has had a stroke, call 9-1-1 for immediate transportation to the nearest hospital. Do not attempt to drive yourself or have someone else drive you, as the emergency medical team in the ambulance can deliver a potentially life-saving diagnosis and care on the way to the hospital, so you don’t have to wait for care.

Diagnosis of Carotid Artery Disease

In addition to taking a medical history and conducting a physical and neurological exam, many procedures are used to diagnose carotid artery disease. These include:

  • Auscultation (listening to) the arteries: Bruits, or abnormal sounds produced by a clogged artery, are a sign of carotid artery disease. A physician can sometimes hear this sound in patients with carotid artery disease, but it is not present in every patient.

  • Carotid ultrasound: Also called a duplex scan, this involves an assessment of the blood flow in the carotid arteries. This can check for obstructions to blood flow.

  • Computed tomography angiography (CTA): This is a more invasive procedure to assess the degree of arterial narrowing by taking x-ray images after injecting a contrast dye. The dye helps the doctor visualize the shape of the blood flow through the arteries.

  • Magnetic resonance angiography (MRA): This uses a combination of magnetic resonance imaging (MRI scan) technology and injected contrast dye to evaluate the blood vessels.

Carotid Artery Disease Treatment

The first line of treatment involves reducing risk factors, such as quitting smoking, eating a nutritious diet, and getting plenty of exercise. Completely stopping any tobacco use is an extremely effective way to reduce the excessive tendency for blood clots. It also helps increase oxygen levels in the blood by preserving the cells that line the arteries and are sensitive to the cigarette toxins. Quitting smoking can reduce or reverse arterial clogging and minimizes your risk of a future stroke.

Medications may also be used to treat carotid artery disease, such as blood pressure medication, antihyperlipidemics to lower fats and cholesterol in the blood, and antiplatelet medications to decrease clots. Over-the-counter aspirin can also help reduce the stickiness of the small blood cells called platelets.

Individuals with carotid artery narrowing greater than 50-70% require more aggressive treatment, particularly if they have symptoms that indicate an imminent stroke. Surgical treatment includes carotid artery stenting, also called carotid endarterectomy. This removes plaque from the carotid arteries and may help prevent a stroke. This is done by inserting a catheter through the groin up to the carotid arteries. A balloon is then used to open the artery, and a stent is placed. The stent is a cylindrical tube made of thin metal-mesh used to hold the artery open, so it cannot narrow again.

Request an appointment online now or call 833-656-3876.