Carotid Artery Disease

Signs and Symptoms

Carotid artery blockages are caused by hardening of the arteries, called atherosclerosis. Risk factors for atherosclerosis include:

• Diabetes
• Smoking cigarettes
• High cholesterol
• High blood pressure

Strokes occur when pieces of the diseased artery break off and travel into the brain, eventually blocking blood flow in the artery, which causes the part of the brain served by the blocked artery to die. This can either cause a full-blown stroke, resulting in permanent neurological problems in a minority of people, a or a transient ischemic attack (TIA), which produces the same symptoms as a stroke but resolves in less than a day, often in a matter of minutes.

Symptoms of both stroke and a transient ischemic attack (TIA) include:

• Weakness or paralysis of a limb or one side of the body
• Inability to speak or articulate clearly
• Blindness or other visual changes in one or both eyes

Along with atherosclerosis there are a number of less common conditions that also can affect the carotid arteries, including:

• Aneurysms, or swelling of the artery
• Carotid body tumors, which are tumor that arises from and involves the carotid arteries
• Recurrent blockages after prior carotid artery surgery
• Fibromuscular dysplasia, an inflammatory condition of the artery
• Inominate artery disease, or blockages in an artery below the carotid artery
• Carotid artery dissections, where the wall of the artery splits

Diagnosis

Fortunately, carotid artery blockages can be diagnosed easily with ultrasound imaging, a painless and safe procedure that is performed on an outpatient basis.

If someone is having symptoms of a stroke or a transient ischemic attack, they should contact their doctor or UCSF Medical Center immediately.

Treatment

A number of large studies completed during the 1990s clearly demonstrated that surgery was the best treatment for reducing the risk of stroke in patients with severe blockages in the carotid arteries. At UCSF Medical Center, our vascular surgeons have over five decades of experience preventing strokes with carotid artery surgery.

Carotid artery surgery involves:

1. Opening the artery
2. Removing the plaque that is causing the narrowing
3. Closing the artery, usually with a synthetic patch

During the surgery, a temporary bypass is often used to allow blood to flow around the area of surgery as it travels to the brain.

Mild to moderate blockages are treated with antiplatelet agents, such as aspirin. In addition, treatment involves identifying and reducing risk factors, such as cigarette smoking and high blood pressure. Ultrasound studies are repeated over time to monitor the blockage and determine if it has progressed to a severe blockage that requires surgery.

Not all patients are able to undergo surgery because of their overall medical condition or other specific factors. There are a number of new non-surgical options available to treat blockages in the carotid arteries, including balloon angioplasty and stents. Both of these procedures use a catheter-guided balloon, inflated in the blocked area, to open up the carotid artery. A metal stent may be inserted to help keep the artery expanded. At this time, the risks of stroke during these procedures and the long-term results of these procedures are still under investigation. Therefore, carotid artery angioplasty and stenting are currently recommended only for patients who are not candidates for conventional surgical treatment.