Understanding Carotid Artery Disease

What is carotid artery disease?

Within your neck are large blood vessels, called carotid arteries, which carry blood from your heart to your brain.

If you were to look inside a healthy carotid artery, it would appear smooth and wide open, providing easy passage for the blood flowing to your brain. However, due to normal aging or unhealthy lifestyle choices, one or more of your carotid arteries can become clogged with plaque, a sticky substance made up of cholesterol, calcium and other materials.

Over time, as plaque continues to build up on your carotid artery walls, you may develop one of several medical conditions that collectively are referred to as carotid artery disease. They include:

• Carotid stenosis occurs when the carotid arteries become so congested and narrow that blood has a hard time passing through them.
• Carotid artery occlusion occurs when the carotid artery becomes completely blocked.
• Carotid dissection is a tear in one of the three layers of tissue that comprise the carotid artery wall. As blood leaks through the torn layer into the remaining layers, a clot may form and restrict blood flow. People with carotid stenosis are at a higher risk of developing carotid dissection.

A fourth type of carotid artery disease, fibromuscular dysplasia, is less common than the conditions described above, but equally serious.

Fibromuscular dysplasia occurs when abnormal cells begin to grow in an artery wall. While this abnormal cell growth can occur anywhere in the body, it often occurs in the carotid arteries and can cause the artery wall to narrow or tear.

These medical conditions share a dangerous feature. Each of them causes reduced blood flow to the brain — which significantly increases your risk of developing a stroke or transient ischemic attack (TIA).

What are the symptoms of carotid artery disease?

Carotid artery disease may be thought of as a "silent" disease because in the early stages, most people have no symptoms. The majority of patients with carotid artery disease are unaware of their condition until it has reached an advanced stage, and they experience symptoms of a stroke or TIA.

If your carotid artery disease has begun to severely impact blood flow to your brain, you may experience the following sudden symptoms that indicate a stroke:

• numbness, weakness or paralysis in an arm, leg or your face, especially on one side of the body
• trouble speaking, including slurred speech
• confusion, including problems understanding speech
• trouble seeing in one or both eyes, including blurred or double vision
• severe headache, with or without vomiting
• dizziness
• loss of balance or coordination, including trouble walking
• breathing problems
• loss of consciousness

Stroke is a medical emergency. If you experience any of these symptoms, please call 911 immediately.

Who is at risk for carotid artery disease?

There are several risk factors that can increase your likelihood of developing carotid artery disease. These include:

• smoking
• high cholesterol
• high blood pressure
• obesity
• diabetes
• sedentary lifestyle (lack of exercise or other physical activity)
• a family history of carotid stenosis
• aging

How is carotid artery disease diagnosed?

If your doctor suspects you have carotid artery disease, he or she will order one or more of the following tests:

• Carotid ultrasound is a painless test that uses sound waves to produce pictures of your carotid arteries, and confirm whether plaque has built up inside of them. The procedure is sometimes combined with Doppler ultrasound, which shows how well blood is moving through your carotid arteries. While ultrasound tests can detect many cases of carotid artery disease, they often are performed in combination with one of the tests below to more precisely assess what is happening inside your arteries.
• A computerized tomography (CT) scan captures X-ray images of your carotid arteries. Your doctor may pair this scan with a special dye injected into your blood stream, so he or she can observe how well blood is flowing through your carotid arteries and into your brain. This is called CT angiography.
• A magnetic resonance imaging (MRI) scan captures 3-D images of your carotid arteries. Your doctor may use a variation of this test, called MR angiography or MRA, which shows your carotid arteries in greater detail.

How is carotid artery disease treated?

If you've been diagnosed with carotid artery disease, your doctor will create a treatment plan for you that is based on several factors, including the severity of your condition, whether or not you're experiencing symptoms and your overall health.

In addition to prescribing medication and lifestyle changes, your doctor may recommend one of the following procedures:

• Carotid endarterectomy is a well-studied surgical procedure that has been used to treat carotid artery disease since the 1950s. During the procedure a surgeon makes an incision in the neck, opens the affected carotid artery, and removes any plaque that is blocking the vessel.
• Carotid angioplasty and stenting is a minimally invasive procedure that does not require open surgery. During the procedure, a surgeon threads a small, flexible tube called a catheter through an artery (usually starting in the groin area) until it reaches the carotid artery. The catheter is used to inflate the narrowed artery with the aid of a tiny balloon, and then insert a tiny device called a stent to keep the artery propped open.

Carotid artery disease care at Lyerly Neurosurgery

Since Lyerly Neurosurgery was founded in 1934, our physicians have cared for thousands of people who need treatment for a brain or spine condition, including those who are at increased risk of stroke due to underlying conditions such as carotid artery disease.

Today our practice continues to build upon a legacy that blends compassion, safety and innovation. Our neurosurgeons provide the full spectrum of evidence-based care, including the latest minimally invasive procedures that can only be offered by neurosurgeons with advanced training and experience.

Together with Baptist Medical Center Jacksonville, our team performs emergency and preventive neurosurgery services, including carotid endarterectomy and carotid angioplasty and stenting.