Occluded Carotid Arteries: Can I Avoid A Stroke?

Carotid artery occlusion refers to the complete blockage of the carotid arteries, which are the two large blood vessels that supply oxygenated blood to the brain. This blockage is usually caused by the buildup of fatty substances, cholesterol deposits, and other waste products called plaque. While carotid artery occlusion significantly increases the risk of stroke, it is possible for an individual to have this condition without experiencing a stroke. This is because the presence or absence of symptoms depends on the extent of the blockage. For instance, individuals with mild to moderate stenosis may not exhibit any symptoms and can go extended periods without experiencing a stroke. However, severe occlusion can lead to a stroke, which can cause serious disability or even death. Therefore, seeking prompt medical attention and implementing recommended lifestyle changes are crucial to managing carotid artery occlusion and reducing the risk of stroke.

Occluded carotid arteries increase the risk of stroke

The carotid arteries are the two large blood vessels that supply oxygenated blood to the brain, neck, and face. Carotid artery occlusion refers to the complete blockage of these arteries, usually caused by the buildup of fatty substances, cholesterol deposits, and, in some cases, calcium. This buildup is called plaque and the condition is called carotid artery stenosis or carotid artery disease.

When the carotid arteries are blocked, the risk of stroke increases. A stroke occurs when blood flow is cut off from the brain. Brain cells can only survive a few minutes without blood or oxygen before they start to die. Strokes can be caused by a variety of conditions, but carotid artery occlusion is a significant risk factor. In fact, approximately 20% of strokes are related to carotid artery occlusive disease.

Carotid artery stenosis is often caused by atherosclerosis, or "hardening of the arteries", which is the buildup of plaque in the arteries. This causes the arteries to narrow, reducing blood flow to the brain. If the narrowing becomes severe, or a piece of plaque breaks off, blood flow to the brain can be blocked, resulting in a stroke.

The risk factors for carotid artery stenosis are similar to those for other types of heart disease. These include hypertension (high blood pressure), abnormal lipids or high cholesterol, a family history of atherosclerosis, and age, with men under 75 having a greater risk than women in the same age group. Lifestyle factors such as a sedentary lifestyle, smoking, and a diet high in saturated fat can also contribute to the development of carotid artery stenosis.

The symptoms of carotid artery stenosis may not be noticeable until a transient ischemic attack (TIA) or stroke occurs. A TIA is a temporary blockage of a small brain artery, often caused by plaque or blood clots, that can cause stroke-like symptoms such as weakness or numbness on one side of the body, loss of vision, and slurred speech. These symptoms usually last only a few hours and then resolve, but they are a warning sign that a stroke may be imminent. It is important to seek medical help immediately if any of these symptoms occur, as quick treatment can be lifesaving.

Atherosclerosis is the main cause of carotid artery occlusion

The carotid arteries are the two main blood vessels that supply oxygenated blood to the brain. They are located on each side of the neck, just below the angle of the jawline. When these arteries become narrowed, it is called carotid artery stenosis, and it can have serious consequences.

Atherosclerosis causes the thickening and narrowing of the carotid arteries, decreasing blood flow or completely blocking it. This reduced blood flow can lead to a transient ischemic attack (TIA) or a stroke. A TIA is a temporary loss of blood flow to the brain, lasting only a few minutes to an hour, with symptoms disappearing within 24 hours. However, a stroke occurs when the blood flow to the brain is blocked for an extended period, causing permanent brain damage.

The risk factors associated with atherosclerosis include a diet high in saturated fat. Knowing these risk factors can help individuals make necessary lifestyle changes and work with their doctors to reduce their chances of developing carotid artery disease.

Transient ischemic attacks (TIAs) are often called mini-strokes

A TIA occurs when there is low blood flow to the brain or a clot briefly blocks an artery supplying blood to the brain. The clot usually dissolves on its own or gets dislodged, and the symptoms usually last less than five minutes, though they can persist for up to 24 hours. During a TIA, brain cells malfunction and start to die due to the lack of blood flow (ischemia).

The symptoms of a TIA are nearly identical to those of a stroke and can include:

• Weakness, numbness, or paralysis on one side of the body
• Slurred speech or difficulty understanding others
• Blindness in one or both eyes
• Severe headache with no apparent cause
• Loss of muscle control on one side of the face or facial drooping
• Blurred or double vision
• Loss of coordination or clumsiness
• Dizziness or vertigo
• Nausea and vomiting
• Emotional instability and personality changes
• Confusion or agitation
• Memory loss
• Passing out or fainting

It is important to note that a TIA is a warning sign that a stroke may occur in the near future. Up to 20% of people who experience a TIA will have a stroke within 90 days, and half of those strokes occur within the first two days after a TIA. Therefore, it is crucial to seek immediate medical attention if you or someone you know is experiencing any of the symptoms of a TIA.

The main difference between a TIA and a stroke is that a TIA stops on its own, while a stroke requires treatment to stop and reverse its effects. Additionally, a stroke leaves behind evidence on a magnetic resonance imaging (MRI) scan, even if the symptoms have resolved.

The risk factors for a TIA are similar to those for a stroke and include:

• High blood pressure (the most significant risk factor)
• Tobacco use
• Atrial fibrillation (irregular heart rhythm)
• History of stroke or TIA
• Heart disease and previous heart attack
• High cholesterol
• Excess weight or obesity
• Drug and alcohol use
• Age (as blood vessels become less flexible with age)

A carotid ultrasound is used to screen for carotid artery occlusive disease

Carotid artery occlusive disease is caused by atherosclerosis, where fatty substances, cholesterol, calcium, and waste products accumulate in the walls of the arteries, causing them to narrow or become blocked. This condition increases the risk of stroke, with approximately 20% of strokes related to carotid artery occlusive disease.

A carotid ultrasound is a non-invasive, painless, and safe screening test that uses high-frequency sound waves to examine the carotid arteries for any narrowing or blockage. It can detect plaques and blood clots and determine if the arteries are narrowed or blocked. This test is particularly useful for screening and monitoring carotid artery occlusive disease. It provides valuable information about the extent of narrowing and the blood flow rate through the carotid arteries.

During a carotid ultrasound, a clear gel is applied to the sides of the neck, which facilitates the transmission of sound waves between the arteries and the transducer. The healthcare provider then presses the transducer against the skin, allowing the sound waves to create images of the carotid arteries' interior. The procedure is quick, typically lasting 30 to 45 minutes, and carries no risks, although patients may feel pressure when the transducer is pressed against their neck.

The results of the carotid ultrasound indicate the extent of any blockage in the arteries, expressed as a percentage. If the blockage exceeds 50% (with stroke or TIA symptoms) or 60% (without symptoms), more aggressive treatment options may be considered, such as lifestyle changes, medications, or even surgery, to reduce the risk of stroke.

Treatment of carotid artery occlusive disease includes lifestyle changes and medication

Carotid artery occlusive disease is caused by atherosclerosis, which is the buildup of fatty substances, cholesterol deposits, and other waste products inside the artery lining. This causes the arteries to narrow and increases the risk of a stroke. While carotid artery occlusive disease can be asymptomatic, it is a serious condition that requires treatment to prevent a stroke. Treatment for carotid artery occlusive disease includes lifestyle changes, medication, and sometimes medical procedures.

Lifestyle Changes

Lifestyle changes are an important part of treating carotid artery occlusive disease. These changes aim to reduce the risk factors associated with the disease and prevent further progression. Recommended lifestyle changes include:

• Controlling high blood pressure: High blood pressure is a significant risk factor for carotid artery occlusive disease and can be managed through a combination of exercise, diet, and medication if necessary.
• Regular check-ups with a doctor: It is important to monitor the condition and the effectiveness of the treatment plan.
• Managing cholesterol: High cholesterol is a risk factor for the disease, so getting it under control is crucial. This can be achieved through diet, and if necessary, with the help of statins as prescribed by a doctor.
• Maintaining a healthy weight: Excess weight can contribute to high blood pressure and cholesterol, so maintaining a healthy weight is important.
• Exercising regularly: Aim for at least 30 minutes of exercise most days of the week. Exercise helps maintain a healthy weight and can also lower blood pressure and cholesterol levels.
• Limiting alcohol consumption: It is recommended to limit alcohol intake to one drink per day for women and two drinks per day for men.
• Quitting smoking: Smoking cessation is crucial to prevent the progression of carotid artery occlusive disease.
• Improving diet: Adopting a heart-healthy diet that is low in saturated fat, processed foods, and high in fresh fruits, vegetables, and lean meats can help lower cholesterol and reduce the risk of carotid artery occlusive disease.

Medication

In addition to lifestyle changes, medication may be prescribed to help reduce the risk of stroke and manage associated conditions. These may include:

• Antiplatelet medications: Drugs such as aspirin, clopidogrel (Plavix), and dipyridamole reduce the risk of stroke by decreasing the formation of blood clots.
• Cholesterol-lowering medications: Statins, such as simvastatin and atorvastatin, are used to lower cholesterol levels and decrease inflammation in the arteries, thereby reducing plaque development.
• Blood pressure-lowering medications: Various drugs can help lower blood pressure, which is an important treatable risk factor for stroke.
• Blood thinners: In some cases, a doctor may prescribe a blood thinner like warfarin (Coumadin) to further reduce the risk of stroke.

Medical Procedures

In cases of severe narrowing or blockage in the carotid artery, medical procedures may be necessary to open the artery and improve blood flow to the brain. Two common procedures are:

• Carotid endarterectomy (CEA): This procedure involves making an incision in the neck to directly access and remove the plaque and diseased portions of the artery. The artery is then sewn back together to improve blood flow.
• Carotid artery stenting (CAS): This is a less invasive procedure where a catheter is threaded to the area of narrowing in the carotid artery through a small puncture in the groin. A balloon is inflated to open the artery, and a stent is placed to hold it open.

Frequently asked questions