Carotid Artery Disease

Carotid artery disease is a disease of blood vessels that supply to brain and head (carotid artery) in which the vessels become clogged due to deposition of fatty substances (plaques). A serious condition called stroke may occur when the blocked arteries cannot supply sufficient blood to brain. Stroke causes a marked decrease in oxygen supply of brain and the brain cells deprived of oxygen start dying within minutes. Stroke is among the top killers and principal cause of permanent disability in the U.S. Carotid artery disease progresses gradually and is initially indicated by a stroke or Transient Ischemic Attack (TIA). TIA refers to transient interruption in the blood flow to your brain.

Treatment of the condition usually involves medications, lifestyle modifications and sometimes surgery.

Initially, Carotid artery disease may be unnoticeable due to lack of any signs or symptoms. The condition often progresses to stroke or TIA without showing the typical signs and symptoms. The signs and symptoms, when present, include:

• Abnormal sensation or weakness in the face or limbs mostly on one side of the body. 
• Speech difficulties
• Vision problems
• Balance problems 
• Severe headache without any cause

When to see a doctor?

Since you cannot differentiate if the signs and symptoms are due to stroke or any other conditions, any of the signs should be considered an emergency and urgent medical help should be sought as soon as you experience the signs. Early diagnosis of Carotid artery disease ensures that you get prompt treatment and prevent the condition from developing into stroke.

Fatty deposits called plaques can cause narrowed and stiffened carotid artery disease. Plaques are the deposits of cholesterol, calcium, fibrous tissue and other cellular debris within the arteries that lead to atherosclerosis. The arteries that are clogged due to plaques are not able to adequately supply oxygen to brain which can result into stroke or TIA.

After your carotid artery disease is diagnosed, your doctor can refer you to a Neurologist (a specialist in brain disorders).

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

List out all the symptoms.

Write down your key medical information. 

Write down the names of all your medications, vitamins or supplements. 

Make a list of the questions to ask your doctor. Some typical questions can be: 

• What are the tests that I need? 
• What are my treatment options? 
• Am I likely to recover completely?
• Do I need to change my lifestyle? 

What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• Do you experience weakness on one side of your body, problems with speaking or vision? 
• When did you start experiencing these symptoms? And how long did they last? 
• Do you drink or smoke? 
• Are you physically active? If so, how do you rate your level of physical activity? 
• Has anyone from your family been diagnosed with a heart disease or stroke? 
• Do you experience spells of breathlessness during sleep?

Your doctor listens to your carotid arteries with a stethoscope. If a swooshing sound called bruit is detected, your doctor then proceeds with further tests such as: 

• Assessment of physical and mental capabilities such as physical strength, memory and speech. Note that the swooshing sound is characteristic of a narrowed artery, possibly due to plaques. 
• Imaging tests include: 

    o Ultrasound, to detect narrowing of carotid arteries.

    o CT or MRI, to look for evidence of stroke or other abnormalities. 

    o CT angiography or MR angiography to obtain images of the arteries to further confirm narrowing of the arteries.

Treatment of Carotid artery disease focuses on preventing stroke and its long term consequences. The treatment choice and outcomes often depend upon the disease severity and general health status. For mild to moderate cases, lifestyle modifications like smoking cessation, weight management, healthy food choices, reduced salt intake and regular physical activity may be recommended. In addition, your doctor can prescribe aspirin and/or cholesterol lowering agents to slow down progression to stroke.

Your doctor can recommend surgeries for severe or repeated cases. The surgery include:

• Carotid endarterectomy: It is the most common surgical procedure to remove plaque from the carotid artery.
• Carotid angioplasty and stenting: If your health does not allow carotid endarterectomy or the narrowed artery is inaccessible, your doctor considers carotid angioplasty and stenting. Carried out under local anesthesia, it involves inserting a catheter attached to a balloon at one end through the arteries to reach narrowed portion of the carotid artery. The balloon is then inflated to widen the artery and a metal mesh stent is used to keep it open over time.

Lifestyle modifications can prevent or slow the progression of Carotid artery disease. Here are some useful tips: 

• Quit smoking: Quitting smoking reduces your risk of a stroke. 
• Keep weight in check: Being obese or overweight is a major risk factor for various conditions like high blood pressure, cardiovascular disease, diabetes, sleep apnea including stroke.
• Lower cholesterol and fat intake: Reduced intake of saturated fat can lower plaque build-up in your arteries. 
• Take a balanced diet: A diet rich in fruits and vegetables protects you against a TIA or stroke. 
• Limit your salt intake: A diet high in sodium increases your blood pressure which is a major risk factor for a stroke or TIA. Experts recommend daily salt intake less than 1,500 milligrams.
• Exercise: Any sort of physical activity, especially cardio are helpful in preventing or managing high blood pressure, high blood cholesterol, obesity, diabetes and stress, all of which are a risk factor for a stroke.
• Drink in moderation: Limiting alcohol intake to a recommended amount can prevent you from the risk of stroke and many other heart conditions.
• Manage chronic illnesses: Chronic illnesses like diabetes, high blood pressure increase your risk for many heart conditions including stroke. Managing these illnesses can help protect your arteries and heart.

There are several risks and complications associated with Carotid artery disease.

Risks

• High blood pressure: High blood pressure puts more pressure on the artery walls making them more sensitive to a stroke or TIA.  

• Tobacco consumption: Nicotine present in the tobacco products harden your arteries and promote formation of plaques. 

• Diabetes: High blood glucose in blood can lead to increased deposits of fats on the arteries which cause their narrowing that results in decreased oxygen supply to the brain. 

• High blood-fat levels: Plaque formation is rapid in patients who have higher blood levels of low-density lipoprotein (LDL-bad cholesterol) and triglycerides.

• Family history:  People with a family history of atherosclerosis are more likely to develop carotid artery disease. 

• Age: Increasing age reduces artery flexibility which increases chances of atherosclerosis and hence a stroke. 

• Obesity: Obesity itself is a major risk factor for a stroke and all other factors like high blood pressure, diabetes that contribute to stroke. 

• Sleep apnea: Episodes of breathlessness during sleep and stroke are closely linked.

• Physical inactivity: Lack of physical activity is a major risk factor for stroke and many other conditions such as high blood pressure, diabetes and obesity. 

Complications

• Carotid artery disease accounts for 10-20% of cases of stroke. Stroke is a medical emergency that can result in permanent brain damage, muscle weakness, many other neurological deficits and neuropsychiatric disorders. Carotid artery disease can lead to stroke through decreased blood flow and ruptured plaques.