Carotid Artery Interventions

Carotid artery disease, also known as carotid artery stenosis, involves narrowing the carotid arteries in the neck, the blood vessels that supply blood to the brain. Often, suffering a transient ischemic attack (TIA) is the first indication that you have carotid artery problems. A TIA is a temporary loss of brain function.

This narrowing is caused by fatty substances and cholesterol called plaque on artery walls. Carotid artery occlusion refers to complete arterial blockage. Coronary artery disease puts you at an increased risk for a stroke, which causes a more permanent loss of function. It is the fifth leading cause of death in the United States and is the leading cause of permanent disability.

When plaque builds and clogs blood vessels, it produces a condition called atherosclerosis. A stroke deprives your brain of oxygen. Within minutes, brain cells begin to die. Cholesterol, calcium fibrous tissue and other cellular debris comprise plaque, which usually forms at microscopic injury sites within your arteries. Narrowed carotid arteries have difficulty delivering the oxygen and vital nutrients your brain needs for daily functioning.

CAROTID ARTERY DISEASE SYMPTOMS

In its early stages, carotid artery disease often doesn’t produce any signs, and it may progress unnoticed until it’s severe enough to deprive your brain of blood, causing a stroke or TIA.

Signs and symptoms of a mini-stroke or TIA include:

• Sudden numbness or weakness in the face or limbs, often on only one side of the body
• Sudden trouble speaking and understanding
• Sudden trouble seeing in one or both eyes
• Sudden loss of balance or dizziness
• Sudden severe headache with no known cause

Seek treatment immediately if you have one or more of these symptoms, even if they disappear as suddenly as they appeared, as this is a medical emergency. Medical treatment is necessary to avoid a full-blown ischemic stroke. Carotid artery disease causes about 10% to 20% of strokes.

How an Ischemic Stroke Can Occur

Carotid artery disease can lead to a stroke through the following:

• Reduced blood flow where the artery becomes so narrow that not enough blood reaches parts of the brain
• A piece of plaque ruptures from a carotid artery, traveling to smaller arteries in the brain where it gets stuck and cuts off blood supply
• Large blood clots that form in carotid arteries due to plaques that crack and form irregular surfaces

Other possible factors that can produce a stroke include:

• Atrial fibrillation
• Cardiomyopathy
• Sudden bleeding in the spinal fluid space

RISK FACTORS FOR CAROTID ARTERY DISEASE

Risk factors for carotid artery problems include:

• High blood pressure, which weakens artery walls and makes them more vulnerable to damage
• The nicotine in cigarettes irritates the inner lining of your arteries, while smoking itself increases heart rate and blood pressure
• Diabetes lowers your ability to process fats efficiently, placing you at greater risk of high blood pressure and atherosclerosis
• High blood-fat levels, particularly low-density lipoprotein (LDL), cholesterol, and triglycerides, which encourage the accumulation of plaques
• Insulin resistance, which accelerates the formation of thrombosis and promotes the development of atherosclerosis
• Other family members who have carotid artery disease or atherosclerosis
• Age makes arteries less flexible and more prone to injury
• Obesity increases the likelihood of hypertension, diabetes and atherosclerosis
• Sleep apnea, with spells of stopped breathing at night, increases your stroke risk
• Lack of exercise contributes to conditions that damage your arteries

TREATMENT OPTIONS

Diagnosis and treatment of carotid artery disease are essential to prevent TIA/stroke. Regular physical exams play an integral part in prevention, as your doctor may listen to your carotid arteries with a stethoscope to detect an abnormal whooshing sound called a bruit. When one is present, it usually indicates turbulent blood flow, a sign of carotid artery disease. Listen for a bruit is a simple and safe way to screen for carotid artery stenosis, although it may not detect all blockages.

Dr. Sidhu will discuss carotid artery disease and may recommend an in-office ultrasound in the office to diagnose the degree of blockage. Other diagnostic imaging tests that we may order for you include magnetic resonance angiography (MRA), computerized tomography angiography (CTA), or cerebral angiography, commonly called a carotid angiogram. Treatment of carotid artery disease usually involves a combination of lifestyle changes, medication and surgery, when necessary. A successful intervention for carotid artery disease involves preventing stroke and the serious complications that may occur.

Mild to Moderate Blockage

Lifestyle changes can be effective in slowing the progression of atherosclerosis. If you fit this category, VIVAA will help you modify your lifestyle through a treatment program that can include:

• Eliminating tobacco use
• Eating a heart-healthy diet with foods low in saturated fats, cholesterol, and sodium
• Maintaining a healthy weight
• Exercising regularly, at least 30 minutes several times per week
• Limiting alcohol consumption
• Medications to lower blood pressure and diabetes and lower cholesterol
• Anti-platelet medicines to reduce the risk of stroke and other cardiovascular disease complications

Severe Blockage

Depending on the severity of the blockage, we will explain all treatment options in detail. If intervention is needed, we will recommend placing a stent across the blockage or performing an open surgical procedure called carotid endarterectomy to fix the carotid artery blockage.

We will discuss each treatment option in detail and develop an individualized plan. Diagnosing and treating carotid artery disease in a timely fashion is essential to prevent a potentially life-threatening event like stroke. These procedures are performed if you have at least a 50-75% blockage with previous symptoms or an 80% blockage without symptoms.

Carotid Endarterectomy

This is the most common treatment for severe carotid artery disease. It can be performed under general or local anesthesia with intravenous sedation. After making an incision along the front of your neck, Dr. Sidhu will open the affected carotid artery and remove the plaques, restoring blood flow to the brain through its normal path. The artery is repaired with either stitches or a graft.

After treatment, you will have a sore throat, and the skin on your neck will be sore. Risks include stroke or TIA in a small percentage of patients who have not had previous symptoms, along with heart attack or nerve damage that can affect your larynx, tongue, or back.

Carotid Angioplasty and Stenting

If the blockage is too difficult to reach with carotid endarterectomy, or if you have other health conditions that make surgery too risky, you’ll undergo this procedure. You’ll receive local anesthesia for the insertion of a tiny balloon via a catheter to the area of the blood clot. It is then inflated to widen the artery. A small wire mesh coil called a stent is inserted to keep the artery from narrowing again.

Patients usually stay in the hospital for one to two days following the procedure. Risks include infection, heavy bleeding, artery injury, allergic reaction, stroke and heart attack. Your risks may vary based on your overall health, the severity of your condition and whether you have other complications such as diabetes or hypertension.

Patient Review

"Dr. Sidhu and his staff were very supportive as he diagnosed and surgically repaired my carotid artery. I felt his warmth and personal concern that comforted me throughout the process."
R.O.

When you need vascular and endovascular procedures or vascular ultrasound, choose the double board-certified surgeon at Vein Vascular, Primary Care & Aesthetic Services. For more information or to make an appointment, call us today at 425-250-9999. For your convenience, you can use our online Request an Appointment form.