Carotid Artery Stenosis
A carotid artery on each side of the neck delivers oxygen-rich blood from the heart to the brain. It can become narrowed due to atherosclerotic plaque, an irregular layer of fibrous tissue containing cholesterol and calcium, which develops in the wall of the blood vessel. This narrowing is called carotid artery stenosis. It is associated with 20–30% of all strokes.
Carotid artery stenosis can lead to a TIA (transient ischemic attack) or a permanent stroke. When the carotid artery is narrowed 70% or more, blood flow to the brain is decreased.
A TIA is actually a “warning” or “mini” stroke. In a TIA, a blood clot or debris blocks the blood flow to a portion of the brain or eye but dissolves or gets washed away before permanent injury occurs. The stroke symptoms of a TIA resolve within several minutes to 24 hours. A permanent stroke, also called a cerebral infarct, occurs when the loss of blood flow lasts too long and brain tissue dies.
A TIA can involve the retina and cause transient loss of vision in one eye. This is called amaurosis fugax. Most TIAs involve the brain. Patients who have a brain or “hemispheric” TIA are at greater risk for having a permanent stroke, especially within the following month and year.
A TIA or stroke is a medical emergency. Recognition of symptoms and early treatment can potentially save a patient from a devastating outcome.
Signs and Symptoms
Carotid artery stenosis produces signs and symptoms related to the lack of blood flow to an area of the brain. These symptoms may be seen with either a TIA or stroke. Symptoms may include:
- Sudden onset of weakness or numbness in the face, arm or leg, usually on one side of the body.
- Sudden dizziness, trouble walking or loss of balance and coordination
- Sudden loss of vision in one eye or possibly both
- Sudden confusion, difficulty with speech or understanding
Carotid artery stenosis may be found by chance on imaging studies obtained for other reasons. Often, the development of a TIA or stroke leads to further evaluation. Diagnosis begins with a medical history and neurological examination. Findings and tests leading to the diagnosis include: carotid bruit , carotid ultrasound , computed tomography angiography ( CTA ), magnetic resonance angiography ( MRA ) and cerebral angiography .
There are different treatment options depending on the severity of your stenosis and your clinical situation:
- Lifestyle changes such as exercise, eating a healthy diet and stopping smoking can slow or stop the buildup of atherosclerosis in your blood vessel walls.
- Medication to treat high blood pressure and “statin” drugs to reduce cholesterol have been found to be very beneficial. Anti-platelet medicines such as aspirin are also used frequently.
- Carotid endarterectomy and carotid angioplasty and stent are procedures done to re-open the carotid artery in the neck and improve blood flow to the brain. Both require a short stay in the hospital. Carotid endarterectomy is a surgical procedure and carotid angioplasty and stent is a neuro-interventional procedure. Both procedures are effective in treating the narrowing and reducing the risk for stroke.
Our Goodman Campbell vascular team is highly skilled. They can discuss all these options with you and help you choose your best form of treatment.