Anna Werrett
Carotid artery disease is a condition that can lead to stroke. It occurs when the carotid arteries, which supply blood to the brain, face and neck, become narrowed and clogged with fatty material. This is called atherosclerosis. When the carotid arteries are obstructed, blood flow to the brain is reduced or blocked, which can cause a stroke. The risk of stroke increases as the narrowing progresses, and severe cases can result in permanent brain damage or even death. Treatment options for carotid artery disease include lifestyle changes, medication, and surgical procedures such as carotid endarterectomy and carotid artery stenting.
| Characteristics | Values |
|---|---|
| What is carotid artery disease? | The carotid arteries are the main blood vessels that carry blood and oxygen to the brain. Carotid artery disease is the narrowing of these arteries, usually caused by the buildup of fatty substances, cholesterol, and other waste products inside the artery lining. |
| What causes carotid artery disease? | Carotid artery disease is caused by atherosclerosis, or the buildup of fatty deposits along the inner layer of the arteries forming plaque. |
| Risk factors | Risk factors for carotid artery disease include a diet high in saturated fat, smoking and tobacco use, a sedentary lifestyle, and high blood pressure. |
| Symptoms of carotid artery disease | There may be no symptoms of carotid artery disease until a transient ischemic attack (TIA) or stroke occurs. Symptoms of a TIA or stroke may include weakness or numbness on one side of the body, loss of vision, slurred speech, sudden dizziness, and sudden severe headache. |
| Diagnosis | Carotid artery disease is often diagnosed after a TIA or stroke, or when a doctor hears an abnormal sound called a bruit or murmur during an exam of the neck with a stethoscope. Imaging tests such as ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA) can also be used to diagnose carotid artery disease. |
| Treatment | Treatment for carotid artery disease includes lifestyle modifications such as a healthy diet, exercise, and stopping smoking, as well as medications to lower blood pressure and cholesterol. In more severe cases, surgical procedures such as carotid endarterectomy or carotid artery stenting may be necessary to remove plaque or open up the artery. |
What You'll Learn
Carotid artery disease
Atherosclerosis causes the carotid arteries to become stiff and clogged, reducing blood flow to the brain. This can lead to a stroke, as brain cells require a constant supply of oxygen and can start dying within minutes of oxygen deprivation. The effects of a stroke depend on its location in the brain and the size of the damaged area.
There are several treatment options for carotid artery disease, including lifestyle changes, medication, and surgery. Lifestyle changes include a healthy diet, regular exercise, weight management, stress control, and smoking cessation. Medications such as antiplatelets, cholesterol-lowering drugs, and blood pressure-lowering drugs can also be prescribed. If the artery is severely narrowed, surgical procedures such as carotid endarterectomy or carotid artery stenting may be recommended.
To prevent or delay carotid artery disease, maintaining a healthy diet, exercising regularly, managing weight, quitting smoking, and controlling stress are crucial.
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Atherosclerosis
The buildup of fatty deposits along the inner layer of the arteries forms plaque, which thickens and narrows the arteries, decreasing or completely blocking blood flow to the brain. This process is called atherosclerosis and can lead to carotid artery stenosis. Risk factors associated with atherosclerosis include a diet high in saturated fat.
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Transient ischemic attack (TIA)
A transient ischemic attack, or TIA, is a temporary blockage of blood flow to the brain, often referred to as a "warning stroke" or "mini-stroke". The symptoms of a TIA are the same as those of a stroke but do not last as long, usually disappearing within 24 hours and sometimes lasting only a few minutes.
TIA symptoms 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 balance and coordination
- Confusion or difficulty in talking or understanding speech
- Trouble walking or dizziness
As the symptoms of a TIA are similar to those of a stroke, it is important to get medical help immediately if you think you are experiencing a TIA. A comprehensive evaluation should be done within 24 hours of the onset of symptoms, including an assessment of symptoms and medical history, imaging of the blood vessels in the head and neck, and other tests such as a head CT, angiography, and MRI.
TIA is often a warning sign that a person is at risk of a more serious stroke in the future. About one-third of people who experience a TIA will have a stroke at some point. However, many strokes can be prevented by heeding the warning signs of TIAs and treating underlying risk factors. Major risk factors for TIA and stroke include high blood pressure, diabetes, heart disease, atrial fibrillation, and smoking.
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Risk factors
Carotid artery disease occurs when the carotid arteries, which supply blood to the brain, become narrowed, clogged, stiff, and filled with fatty material. This is called atherosclerosis and can lead to a stroke.
There are several risk factors that can increase the chances of having a stroke due to carotid artery disease. Here are some of the key factors:
- Age: The risk of having a stroke increases with age. The chances of having a stroke about double every 10 years after the age of 55.
- Previous Stroke or Transient Ischemic Attack (TIA): If an individual has already experienced a stroke or TIA, their chances of having another stroke are higher.
- High Blood Pressure: High blood pressure is a leading cause of stroke. It can lead to a blockage in the brain, known as an ischaemic stroke, or sudden bleeding in the brain, known as a hemorrhagic stroke.
- Cholesterol: High cholesterol levels can cause a build-up of cholesterol in the arteries, including those in the brain, leading to narrowing and an increased risk of stroke.
- Heart Disorders: Common heart conditions such as coronary artery disease, heart valve defects, irregular heartbeat (atrial fibrillation), and enlarged heart chambers can increase the risk of blood clots that may cause a stroke.
- Diabetes: Diabetes can cause a build-up of sugars in the blood, preventing oxygen and nutrients from reaching the brain. Additionally, people with diabetes often have high blood pressure, which further increases the risk of stroke.
- Obesity: Obesity is linked to higher levels of "bad" cholesterol and lower levels of "good" cholesterol. It can also contribute to high blood pressure and diabetes, both of which are risk factors for stroke.
- Sickle Cell Disease: This blood disorder is linked to ischemic stroke, particularly in Black children. Sickle cell disease can cause a blockage in blood vessels, including those in the brain, leading to a stroke.
- Lifestyle Choices: Certain lifestyle choices can increase the risk of stroke. These include a diet high in saturated fats, trans fat, and cholesterol; physical inactivity; excessive alcohol consumption; and tobacco use.
- Genetics and Family History: Stroke risk can be higher in some families due to shared genes, behaviours, and environments. Additionally, individuals with a family history of stroke, particularly at a younger age, are at an increased risk.
- Race and Ethnicity: In the United States, stroke occurs more frequently in Black, Alaska Native, American Indian, and Hispanic adults compared to White adults.
- Sex: While men are more likely to have a stroke at younger ages, women tend to have a higher lifetime risk due to their longer life expectancy. Additionally, women who take birth control pills, use hormone replacement therapy, or are pregnant face higher risks.
- Other Medical Conditions: Conditions such as sleep apnea, kidney disease, migraine headaches, anxiety, depression, and high-stress levels are also associated with an increased risk of stroke.
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Treatment
Immediate Treatment
If you suspect that you or someone else is having a stroke, call 911 or your local emergency number right away. The quicker a stroke is treated, the more likely a person will recover without disability. Emergency medical services (EMS) will begin treatment on the way to the hospital, and patients who arrive by ambulance may receive a quicker diagnosis and treatment. Brain scans will determine the type of stroke, and a neurologist or neurosurgeon may be consulted.
For an ischemic stroke caused by a blood clot, the patient may receive a thrombolytic (clot-busting) drug if they arrive at the hospital within 3 hours of the first symptoms. Tissue plasminogen activator (tPA) is a common thrombolytic that improves the chances of recovery. Doctors may also treat ischemic strokes with blood thinners or surgery to remove the clot.
For a hemorrhagic stroke caused by bleeding in the brain, other medicines, surgery, or procedures may be needed to stop the bleeding and save brain tissue. Endovascular procedures can repair a weak spot or break in a blood vessel, and surgery can be performed to stop the bleeding, such as placing a metal clip to stop blood loss from a ruptured aneurysm.
Long-Term Treatment and Prevention
After a stroke, it is important to work with your healthcare team to prevent another one. Your doctor may prescribe medications or recommend lifestyle changes, such as diet and exercise modifications, to lower your risk factors. Surgery may also be beneficial in some cases.
If carotid artery disease is the underlying cause of the stroke, treatment options include medication and surgical procedures to reduce the risk of another stroke. If the carotid artery is less than 50% narrowed, medication and lifestyle changes are often recommended. These may include quitting smoking, lowering cholesterol and blood sugar, exercising, and controlling blood pressure. Medications such as antiplatelets, cholesterol-lowering drugs, and blood pressure-lowering drugs can be used to treat carotid artery stenosis.
If the carotid artery is between 50% and 70% narrowed, medicine or surgery may be considered. There are two main surgical procedures for carotid artery disease: carotid endarterectomy, which involves removing plaque and blood clots from the carotid arteries, and carotid artery stenting, which uses a mesh cylinder to keep the artery open without opening up the neck. The choice of procedure depends on the patient's overall health, expected outcome, and personal preference.
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Frequently asked questions
A stroke, sometimes called a "brain attack", occurs when blood flow is cut off from part of the brain. If the lack of blood flow lasts for more than three to six hours, the damage is usually permanent.
Symptoms of a stroke may include:
- Sudden loss of vision, blurred vision, or difficulty seeing out of one or both eyes
- Weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg
- Sudden difficulty in walking, loss of balance, lack of coordination
- Sudden dizziness and/or confusion
- Difficulty speaking (called aphasia)
- Sudden severe headache
- Problems with memory
- Difficulty swallowing (called dysphagia)
Carotid artery disease happens when the carotid arteries, which supply blood to the brain, face, and neck, become narrowed and clogged with fatty material. This narrowing, or stenosis, reduces the flow of oxygen to the brain, which needs a constant supply of oxygen to work. When the narrowing becomes severe enough, it can block blood flow and cause a stroke.
Treatment for carotid artery disease includes lifestyle changes such as a healthy diet, exercise, and stopping smoking. Doctors may also recommend medications to lower blood pressure and cholesterol. In more severe cases, a surgical procedure called carotid endarterectomy may be used to remove plaque from the carotid artery. Alternatively, a surgeon may place a stent through a puncture in the blocked artery to open it up and hold it in place.
