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Carotid Artery Disease

What are the carotid arteries?

Your 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. You can feel your carotid arteries by feeling the pulse on your lower neck, on either side of your windpipe. The carotid arteries supply the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside. There are two smaller arteries, the vertebral arteries, which run through the spine and supply the back part of the brain (the brainstem and cerebellum).

Carotid artery disease


What is carotid artery disease?

Like the blood vessels of the heart (coronary arteries), the carotid arteries also develop atherosclerosis, the build-up of fat and cholesterol deposits, called plaque, on the inside of the arteries. Over time, the build-up narrows the artery, decreases blood flow to the brain and can lead to a stroke. A stroke can occur if

  • the artery becomes extremely narrowed
  • a piece of plaque breaks off and travels to the smaller arteries of the brain
  • a clot forms and blocks a narrowed artery

A stroke is similar to a heart attack. A stroke occurs when brain cells (neurons) are deprived of the oxygen and glucose carried to them by blood. Oxygen and glucose are essential for neurons to function and survive. If the lack of blood flow lasts for more than 3 to 6 hours, the damage is usually permanent.

What are the risk factors for carotid artery disease?

The risk factors for carotid artery disease is similar to those for coronary artery disease:

  • Family history of atherosclerosis (either coronary artery disease or carotid artery disease)
  • Age (greater in men than women less than age 75, but higher in women after age 75)
  • Smoking
  • Hypertension
  • Diabetes
  • High low density lipoprotein (LDL, bad cholesterol) - although this link is not as strong as it is for coronary artery disease

If you have coronary artery disease, you are more likely to get carotid artery disease.

What are the symptoms of carotid artery disease?

There may not be any symptoms of carotid artery disease. However, there are warning signs of a stroke. A transient ischemic attack (also called TIA or "mini-stroke") is one of the most important warning signs of a stroke, and is a strong indicator of carotid artery disease. A TIA is a temporary episode of:

  • blurred or loss of vision in one or both eyes
  • weakness and/or numbness of your arm, leg or face on one side of your body
  • slurring of speech, difficulty talking or understanding what others are saying
  • loss of coordination, dizziness or confusion
  • trouble swallowing

A TIA may last a few minutes or a few hours. A TIA is a medical emergency since it is impossible to predict if it will progress into a major stroke. If you or someone you knows experiences these symptoms, get emergency help (Call 9-1-1 in most areas). Immediate treatment can save your life or increase your chance of full recovery.

How is carotid artery disease diagnosed?

Carotid artery disease may not have symptoms. It is important for those at risk for carotid artery disease to have regular physical exams by their doctor. A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (BROO-ee) may indicate you have carotid artery disease. Bruits are not always present when blockages are present and may be heard at times even with minor blockages. It is important to let your doctor know if you have had any symptoms of carotid artery disease, such as those listed above.

Diagnostic tests for carotid artery disease include:

  • Carotid Duplex Ultrasound - An imaging procedure that uses high-frequency sound waves to view the blood vessels in the neck and to determine the presence of narrowing in the carotid arteries. This study is recommended in anyone with heart disease and anyone over the age of 60.
  • Carotid Angiography (carotid angiogram, carotid arteriogram, carotid angio) - If carotid artery disease is suspected, prior to treatment, your doctor may schedule an arteriogram. This is an invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the carotid arteries with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your carotid arteries are taken.
  • Computerized Tomography (CT Scan) - a CT of the brain may be performed if there is a possibility a stroke has already occurred. This test will reveal areas of damage on the brain.

How is carotid artery disease treated?

Carotid artery disease is treated by:

  • Lifestyle modification
  • Medications
  • Procedures

Lifestyle modification

To prevent further progression of disease, lifestyle modification is recommended to limit all risk factors for coronary 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
  • Eat foods low in saturated fats and cholesterol
  • 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

Blood-thinner (anticoagulant) medications - all patients with carotid disease should be on aspirin to decrease the risk of stroke due to blood clots. In some cases, Coumadin (warfarin) may be prescribed. If so, bloodwork will need to be checked regularly to ensure you are on the proper dose.

Procedures

If the carotid artery has severe narrowing or blockage, a procedure must be done to open the artery and allow blood flow to the brain, to prevent future stroke:

Stent in Artery

  • Carotid Stenting - This interventional procedure is currently under investigation. Performed in a catheterization laboratory, a small puncture is made in the groin. A specially designed catheter, with an umbrella tip is placed over a guide wire,and directed to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to dilate the artery. Then, the stent (a small stainless steel mesh tube that acts as a scaffold to provide support inside your artery) is placed in the artery and opens to fit the size of the artery. Tiny filters are used to capture any particles that are released and prevent them from going to the brain and causing a stroke. The stent stays in place permanently. After several weeks, your artery heals around the stent. Research is underway to study the effectiveness and safety of carotid stenting. It is hoped this procedure will offer a non-surgical option to treat carotid artery disease. For more information, click here.
  • Carotid endarterectomy - This is the standard surgical treatment for carotid artery disease. While the patient is under general anesthesia, an incision is made in the neck, at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow blood flow to the brain.

How to find a doctor if you have Carotid Artery Disease

Search by specialty or disease/condition, to find a physician who treats carotid artery disease and performs carotid stenting.

Resources

Related publications written by Miller Family Heart & Vascular Institute physicians

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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