Patient education: Carotid artery disease (The Basics)

What is carotid artery disease? — Carotid artery disease is a condition that can increase a person's risk of having a stroke. It happens when fatty deposits called plaque build up inside blood vessels called the "carotid arteries." These are the 2 main blood vessels that bring blood to the brain. When plaque forms in these arteries, the arteries can become narrow (figure 1).

What are the symptoms of carotid artery disease? — Carotid artery disease can cause strokes and TIAs (described below), though it does not always cause symptoms.

●Strokes – A stroke is when a part of the brain is damaged because of a problem with blood flow. Carotid artery disease can lead to strokes, because blood clots can form inside the narrowed artery. Then, the clots and other material from the fatty plaque can travel to the brain and clog smaller arteries.

Some people recover from strokes without lasting effects or with only minor problems. But many people have serious problems after a stroke. After a stroke, some people are:

•Unable to speak or understand speech

•Paralyzed on 1 side of their body

•Unable to dress, feed, or take care of themselves

●TIAs – TIA stands for "transient ischemic attack." TIAs are basically strokes that last only a short time. But they do not cause brain damage. TIAs happen when a blood vessel in the brain gets clogged briefly and then reopens. People who have TIAs can have the symptoms of a stroke, but the symptoms go away after a short time. People who have TIAs are at very high risk of having a full-blown stroke.

Is there a test for carotid artery disease? — Yes. Doctors can use 1 of the following tests, which create pictures of the arteries:

●Carotid duplex ultrasound – This test uses sound waves to create pictures.

●Magnetic resonance angiography ("MRA") – This test uses a magnet to create pictures. It works the same way that MRI tests work. Before the MRA, most people get an injection of a dye that makes the arteries show up more clearly.

●Computed tomography angiography ("CTA") – This test uses a special kind of X-ray called a CT scan. Before the scan, people get an injection of a dye that makes the arteries show up more clearly.

There is another test that doctors sometimes use, called a "cerebral angiogram." But that is not usually necessary.

How is carotid artery disease treated? — Treatments for carotid artery disease focus mostly on preventing stroke. Treatments can include:

●Lifestyle changes – People can reduce their risk of stroke if they:

•Quit smoking, if they smoke

•Are active

•Lose weight, if they are overweight

•Eat a diet low in fat and cholesterol and high in fruits, vegetables, and low-fat dairy foods

●Medicines – Different people need different medicines to reduce their chances of having a stroke. In general, the medicines that can help prevent strokes include:

•Medicines to lower blood pressure

•Medicines called statins, which lower cholesterol

•Medicines to prevent blood clots, such as aspirin

●Surgery – Doctors can do surgery to remove plaque from the carotid arteries. This is called "carotid endarterectomy." This treatment is most appropriate for people who have had a recent TIA or stroke caused by plaque in 1 of their carotid arteries.

●Carotid stenting – Carotid stenting is when doctors insert a tiny metal tube called a "stent" into the carotid artery. The stent is designed to prop open narrowed arteries. There are 2 main ways to get the stent into the proper position. One way involves inserting it through a blood vessel in the groin (inner thigh) and moving it up through other blood vessels up to the carotid artery. The other way involves making a small cut low in the neck and putting the stent directly into the carotid artery.

Which treatment is right for me? — The right treatment for you depends on:

●Whether you have already had a stroke or TIA caused by carotid artery disease

●How much of your carotid artery is blocked off by plaque

●How old you are

●Whether you have other health problems besides carotid artery disease

If your doctor suggests surgery or stenting, ask these questions:

●What are the chances that I will have a stroke in the next 5 years if I do not have this procedure?

●How much will the procedure reduce my risk of having a stroke in the next 5 years?

●What are the risks of the procedure?

●Does the doctor who will do the procedure have a lot of experience?

More on this topic

Patient education: Stroke (The Basics)
Patient education: High blood pressure in adults (The Basics)
Patient education: High cholesterol (The Basics)
Patient education: Duplex ultrasound (The Basics)
Patient education: Vagal maneuvers (The Basics)
Patient education: Computed tomographic angiography (The Basics)
Patient education: Carotid endarterectomy (The Basics)
Patient education: Carotid ultrasound (The Basics)