Carotid Artery Disease

Carotid artery disease (CAD), or carotid artery stenosis, occurs when the carotid arteries begin to narrow. Narrowed blood vessels are caused by atherosclerosis, an excessive buildup of plaque within the walls of the blood vessels.

What is Carotid Artery Disease?

Plaque is an unhealthy combination of fat, cholesterol, cellular waste, calcium, and proteins that cause blood clotting. Overtime, this plaque can harden, thus blocking the normal, healthy blood flow that the carotid arteries supply to the brain. Patients with carotid artery disease are at higher risk for stroke. Strokes are the 5th leading cause of death in the United States.

carotid artery disease or carotid artery stenosis diagram.

What are the Carotid Arteries?

The carotid arteries are the two large blood vessels located on either side of the neck. They supply fresh blood to the front of the brain. This section of the brain is responsible for overseeing your ability to think, speak, foster personality characteristics, and develop sensory/motor skills. You can feel your pulse in these arteries if you place your fingertips just below the jawline.

What are the Symptoms of Carotid Artery Disease?

CAD develops gradually, meaning symptoms may not become apparent until affected individuals have a stroke or a transient ischemic attack (TIA).

A stroke occurs when the brain is deprived of oxygenated blood. The brain needs fresh blood to function properly. Even a few minutes without proper blood flow can cause the brain cells to die. In patients that have CAD, this can happen in two different ways. First, small pieces of plaque travel from your narrowed arteries to your brain. The carotid arteries can become so narrowed from plaque buildup that a blockage forms, hindering fresh blood from traveling up to the brain. Secondly, plaque can break off into small pieces and attach itself to platelets that travel up towards the brain. These pieces of plaque also create blockages of blood flow to the brain, therefore increasing the risk of a stroke.  

A “mini stroke,” or transient ischemic attack (TIA) is a sudden and temporary loss of blood flow to the brain. This is typically a precursor to a stroke. A TIA can last anywhere from a few minutes to an hour. Within 24 hours, symptoms should dissipate entirely. However, if they persist, you are likely having a stroke. Research shows that individuals who have had a TIA in the past are 10 times more likely to suffer a major stroke. 

  • Drooping on one side of your face
  • Slurred speech
  • Trouble forming words or communicating
  • Vision loss in one eye (patients may feel as though a dark shade has come over their field of vision)
  • Loss of coordination or movement
  • Numbness on one side of the body
  • General confusion or inability to concentrate
  • Dizziness, fainting, or headache

What Risk Factors are Associated with Carotid Artery Disease?

There are several factors that can increase one’s risk of developing carotid artery disease. Habitual lifestyle changes, such as a healthy diet and exercise, can help to combat this condition. However, some of these factors are inevitable, meaning patients should prioritize monitoring their CAD closely.

  • Smoking
  • Obesity
  • Sedentary Lifestyle
  • Diabetes
  • Insulin Resistance
  • High Blood Pressure
  • High Cholesterol
  • Old Age
  • Family History of Atherosclerosis or Arterial Disease

How is Carotid Artery Disease Classified?

Carotid artery disease is typically divided into three different categories: mild, moderate, and severe. Each category classifies the arterial blockages that can be seen in carotid artery disease at varying levels of severity. First, a mild blockage is one that’s less than 50%, meaning less than half the artery is blocked with plaque buildup. Next, a blockage would be considered moderate if the artery is between 50% and 79% blocked. Finally, an arterial blockage may be classified as severe, which means most of the artery is blocked. This is extremely dangerous and could range anywhere from 80% to 99%.

Diagnosing Carotid Artery Disease

To diagnose carotid artery disease, our Vascular Surgeon can perform different kinds of tests that will determine if you have CAD. Additionally, these tests can also define the size of the arterial blockages and where they are located within the arterial walls.

We can look to see if you have carotid artery disease by listening to your arteries with a stethoscope. More specifically, we will be listening for a bruit, an abnormal sound indicating that blood is passing through a narrowed artery.

This method uses sound waves to determine if there is blocked blood flow in the arteries. A small probe, also known as a transducer, is used to send sound waves out to specific angles and locations on the carotid arteries. It is listening for ultrasonic sound waves that move from the body’s tissues to the blood vessels. Similar to a microphone, the transducer amplifies these sound waves so the physician can hear them. If the sound is faint or absent, it may indicate that blood flow is blocked.

Using a combination of magnets, radiofrequency energy, and a computer- an MRI takes detailed pictures of your body’s internal structure. These pictures will allow your physician to get a closer look at how your carotid arteries are functioning. During an MRI scan, patients lie in a giant tube while magnets rotate around the body.

A physician will inject contrast dye through an IV tube to make blood vessels visible on an MRI scan. Afterwards, the doctor will examine the images from the MRI to determine if you have CAD.

X-rays, computer technology, and contrast dye are all used here to create horizontal images of the body. This type of scan shows pictures of the blood vessels that will help the physician identify which arteries are narrowed or blocked.

X-ray images will be taken of your carotid arteries to determine how severe the blockage is. Using contrast dye to make the blood vessels visible, the physician will be able to analyze the shape of the blood vessels and the functionality of the arterial blood flow.   

Carotid Artery Disease Treatment at Monterey Bay Vascular

We understand how serious carotid artery disease is. If left untreated, CAD can lead to life-threatening health problems. During the diagnostic process, our team at Monterey Bay Vascular will not only provide you with a top-quality care experience, but also a personalized treatment plan. There are a few factors that will influence how your treatment plan is formulated, such as your age, overall medical history, the severity of your condition, how you handle certain medications or procedures, and your personal preferences.

Carotid artery disease can be treated with lifestyle changes, medications, and surgical procedures. Treatment plans can be made based on the severity of the blocked artery. For example, if an artery is considered mild (less than 50% blocked), medication and lifestyle changes are a typical treatment route. However, blockages that are over 50% blocked (considered mild or severe), may require medications and surgery.

Certain habitual changes can be implemented at home that will combat the effects of carotid artery disease.

  • Quit Smoking: All nicotine products constrict the blood vessels. If you currently smoke and have carotid artery disease, quitting will help to strengthen your blood vessels.
  • Blood Glucose Maintenance: High blood sugar not only damages the arteries, but can also raise cholesterol levels, both of which can worsen carotid artery disease. Blood glucose can be controlled through low-sugar diets and regular exercise. If you are diabetic, insulin medication may be needed to keep blood sugar levels under control.
  • Blood Pressure Maintenance: Blood pressure levels that are consistently high can also damage arteries. Inflamed arteries increase one’s risk of developing carotid artery disease. Most people should aim to keep their blood pressure levels at or below 140/90.
  • Cholesterol Maintenance: Your body needs some cholesterol to digest food, build cells, and make hormones. However, if cholesterol levels are too high, it can damage the arteries. Eating a healthy diet of lean meat, fruits, and vegetables can help to keep cholesterol levels in check.

The following medications may be used to treat carotid artery disease.

  • Antiplatelets: This type of medication makes the platelets in the blood less likely to bind together and cause blood clots. A few examples of antiplatelet medications include Acetylsalicylic Acid (Aspirin), Clopidogrel (Plavix), Prasugrel (Effient), and Ticagrelor (Brilinta)
  • Cholesterol Maintenance Medication: Medications that lower cholesterol levels are also known as statins. Statins have been proven to help decrease the thickness of plaque around the arterial wall and increase the opening of the artery.
  • Blood Pressure Maintenance Medication: Blood pressure medicine works to keep levels under control by relaxing blood vessels. This will decrease the force at which your heart beats and block nerve activity that can cause blood vessels to restrict.

Some patients affected by carotid artery disease may require a more aggressive treatment plan, especially if the carotid artery is over 50% blocked. A surgical procedure will usually be recommended if the carotid artery is over 70% blocked. There are two different types of surgical procedures that can be performed to treat carotid artery disease.

  • Carotid Endarterectomy (CEA): This procedure is done to clean out the plaque buildup that has accumulated in the carotid artery and ultimately prevent a stroke. Performed under local or general anesthesia, a vascular surgeon will begin by making an incision at the front of your neck. After the plaque is removed, the surgeon creates a natural graft (using a small portion of vein from somewhere else in your body) to close and repair the artery. This treatment method is typically recommended for patients with a moderate (50-79%) or severe (80% or more) blockage in their carotid arteries.
  • Carotid Artery Angioplasty with Stenting (CAS): If you are unable to have a CEA procedure, your physician may recommend a carotid artery angioplasty with stenting. This is a minimally invasive method in which a catheter, small balloon, and stent are used to open the narrowed carotid arteries. First, a vascular surgeon will insert a catheter into one of the blood vessels in your groin. Then, the surgeon guides the catheter upwards toward your carotid arteries. Once the catheter is in place, a small balloon is inflated at the tip of the catheter to help widen the narrowed carotid artery. A stent is also placed in the artery. Years of plaque buildup can weaken arterial walls. Stents are wiry, mesh tubes that act as internal support systems for the damaged arteries. They can even be coated with medications to prevent future plaque buildup. After the balloon is removed, the stent will remain to keep the artery open.

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Why Monterey Bay Vascular?

At Monterey Bay Vascular, we provide individualized treatment options that help in minimizing pain, curing sores, and prevent limb amputation. Our main goal is to stop the disease progression and improve your overall quality of life. Our patient care does not stop after you walk out of our facility. We schedule follow-up appointments that help us to evaluate the results and recovery. Our team will also provide you with answers to your concerns or questions after every appointment, diagnostic test, and medical procedure. We strive to offer all our patients the best possible results that will allow you to get back to doing the things you love as quickly as possible.