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Cerebrovascular Occlusive Disease

Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. These are the blood vessels that supply the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside

Carotid arteries may develop atherosclerosis, the buildup of fat and cholesterol deposits, called plaque, on the inside of the arteries. Over time, the buildup narrows the artery, decreases blood flow to the brain and can lead to a stroke. A stroke can occur if:

  • A piece of plaque breaks off and travels to the smaller arteries of the brain (also called embolization)
  • The artery becomes extremely narrowed
  • A clot forms and completely blocks a narrowed artery

The most common of these ways in which stroke can occur due to a carotid artery, however, is embolization. Learn more about the symptoms and diagnosis, and treatment of carotid artery disease.

When is it necessary to have either surgery or carotid stenting for carotid artery disease?

If the carotid artery has severe narrowing or blockage, an individual is at risk for embolization, where debris in the area of narrowing can break off and head upstream into a blood vessel in the brain blocking the supply of oxygen to cells in the brain. To reduce this risk, a procedure must be done to open the artery and allow blood flow to the brain. In such instances, a stroke could occur if patient does not receive treatment for carotid artery disease.

In some instances, patients will have the symptoms of stroke that will occur for a short period of time. This is sometimes referred to as a "mini-stroke" and is a strong indicator of significant risk for a more severe subsequent stroke, especially in the setting of carotid artery narrowing. In those patients with carotid artery disease and "mini-stroke" or transient ischemic attacks (TIA), the carotid artery should be treated to relieve the narrowing.

If a patient has a stroke, it is important to get an Emergency Room to obtain prompt medical treatment within three to six hours.

What are the treatment options for carotid artery disease and cerebrovascular occlusive disease?

Carotid artery disease treatments include:

  • Lifestyle modification
  • Medications
  • Surgery/Carotid stenting to reduce the narrowing in the artery

Stroke:

Nonsurgical Carotid Artery Disease Treatment Options

Lifestyle modification

To prevent further progression of carotid artery disease, lifestyle modification is recommended to limit all risk factors for development of atherosclerosis and carotid artery disease. These include:

  • Quit smoking and using tobacco products
  • Control high blood pressure and diabetes
  • Have regular check-ups with your doctor
  • Have your doctor check your lipid profile and get treatment, if necessary to reach a lipid goal of LDL less than 100 and HDL greater than 45 (these lipid goals may be modified if you already have evidence of plaque in the arteries)
  • Eat foods low in saturated fats and cholesterol and avoid trans-fats
  • Achieve and maintain a desirable weight
  • Exercise regularly
  • Control other stroke risk factors: limit the amount of alcohol you drink and if you have atrial fibrillation, you should be on blood-thinning medications

Medications for Carotid Artery Disease Treatment

Blood-thinner (anticoagulant) medications come it two varieties. The first are those that keep platelets from sticking together. The most common of these drugs is aspirin. All patients with carotid artery disease should be on aspirin to decrease the risk of stroke due to embolization. The other variety of blood-thinning medication is designed to keep the proteins in blood from clotting, and the most commonly used of these medicines is coumadin. Coumadin (warfarin) may be prescribed in situations where clotting of blood is more common such as in patients with atrial fibrillation or in patients with certain types of heart valves. If coumadin is prescribed, bloodwork to assess the clotting system of the blood will need to be checked regularly to ensure you are on the proper dose.

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart and Vascular Institute Outcomes.

Cleveland Clinic Heart and Vascular Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart and Vascular Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart and Vascular Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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