Carotid Artery Disease
Neuroscience Institute Swedish Cerebrovascular Center
What is carotid artery disease?
The carotid arteries are two large blood vessels that deliver blood to your brain. Carotid artery disease, also known as carotid atherosclerosis, occurs when there is a buildup of plaque in these arteries.
Plaque is a buildup of fatty substances and cholesterol. Over time, buildup of plaque in these blood vessels decreases the blood supply to your brain, and increases your risk of stroke. Risk factors for stroke include smoking, high blood pressure, high cholesterol, and obesity.
This image shows areas where plaque commonly builds up inside the carotid arteries.
Symptoms of Carotid Disease
There are often no symptoms of carotid artery disease until you have a TIA (mini-stroke) or a stroke.
A stroke can occur if:
- An artery becomes extremely narrow
- A piece of plaque breaks off and becomes lodged in a smaller blood vessel
- A blood clot forms and obstructs a blood vessel
- There is a rupture in a blood vessel
The signs and symptoms below may indicate someone is having a stroke. A brief episode of these symptoms may indicate a transient ischemic attack (TIA). Many TIAs last less than five minutes.
- Trouble walking – stumbling or sudden dizziness, loss of balance or loss of coordination
- Trouble speaking and understanding – possible confusion, slurring your words or being unable to find the right words to explain what is happening to you (aphasia). Try to repeat a simple sentence. If you can't, you may be having a stroke.
- Paralysis or numbness on one side of body or face - sudden numbness, weakness or paralysis on one side of your body. Try to raise both arms over your head at the same time. If one arm begins to fall, you may be having a stroke. Similarly, one side of your mouth may droop when you try to smile.
- Trouble with vision - may suddenly have blurred or blackened vision, or you may see double
- Headache – a sudden, severe "bolt out of the blue" headache, sometimes accompanied by vomiting, dizziness or altered consciousness, may indicate you're having a stroke.
- A TIA is a short episode of strokelike symptoms that usually go away within 24 hours. If you have any stroke symptoms, call 911 right away.
How is carotid disease diagnosed?
Your doctor may listen to the arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard over an artery, it may reflect turbulent blood flow, which could indicate carotid artery disease.
There are other specialized tests that can be used to diagnose carotid disease, including:
• Carotid ultrasound - Also known as a carotid vertebral duplex exam, this noninvasive, painless screening test uses ultrasound to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked. A Doppler ultrasound shows movement of blood through the blood vessels. Ultrasound imaging does not use X-rays.
• Magnetic resonance angiography (MRA) - This imaging technique uses a powerful magnet (an MRI) to gather accurate information about the brain and arteries. Then, a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain.
• Computerized tomography angiography (CTA) - More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross-sectional images of the carotid arteries. Images of the brain can be collected as well. With this test, the scan may reveal areas of damage on the brain. The CT scan uses a low level of radiation.
• Cerebral angiography (carotid angiogram) - This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications.
Carotid Endarterectomy (CEA)
Carotid endarterectomy is the removal of plaque from the carotid artery through an incision in the neck. This surgery has very low risk of stroke or complication. It typically involves a quick recovery with little pain.
While you’re under general anesthesia, an incision is made in the neck near the blockage. The surgeon then surgically removes the plaque and diseased portions of the artery. Then, the artery is sewn back together, allowing improved blood flow to the brain.
Is surgery right for you?
The risks and benefits of CEA depend on your age, the degree of blockage, and whether you’ve had a stroke or TIA. Once you have been diagnosed with carotid artery disease, you and your doctor will discuss all of your treatment options. In planning your treatment, your doctor will consider your particular situation before making a recommendation.
We invite you to call the Swedish Cerebrovascular Center at 206-320-3470 to talk with one of our specialists if you would like more information or a second opinion.