Carotid Artery Disease: Understanding this Pre-Stroke Condition

“Check the neck.” This simple mantra is one important way to help detect carotid artery disease, a primary cause of stroke and stroke-like symptoms.

The carotid arteries deliver oxygen-rich blood from the heart to both the head and brain via four carotid arteries in the neck, with a pair located on each side.

It’s important for individuals to know their risk of this disease—and how to manage it. Jorge Eller, MD, MBA, board-certified and fellowship-trained cerebrovascular and endovascular Crouse neurosurgeon, says detection and prompt treatment of carotid artery disease is vital in preventing life-altering debilitation or death.

What Causes Carotid Artery Disease?
Carotid disease, or carotid stenosis, is a narrowing of the diameter of a carotid artery. The blood vessel becomes smaller, which results in less blood flow to the brain. The risk factors for carotid disease are essentially the same as risk factors for vascular disease elsewhere in the body, including the heart. For example, high blood pressure, uncontrolled diabetes, high cholesterol and smoking adversely affect the normal functioning of the carotid arteries.

“The narrowing of the carotid artery is usually caused by what we call plaque, which is consistent with cholesterol and platelets—a constituent of the blood that forms clots, the cells in the bloodstream that lead to clot formation,” explains Dr. Eller. “So, they can get stuck to this cholesterol layer in the carotid, and there’s sometimes calcification.”

Another reason for carotid disease development relates to bifurcation, which occurs when a carotid artery splits into the internal carotid and the external carotid. Where those bifurcations exist is an ideal place for plaque to form and for the vessel diameter to narrow significantly.

What Are the Symptoms of Carotid Artery Disease?
Symptoms associated with carotid stenosis are the same symptoms one would associate with stroke. For instance, weakness, numbness, or tingling on one side of the body, trouble with vision, or speech difficulties.

Another common symptom is when a small piece of plaque breaks off and migrates distally, ending up in the small blood vessel in the eye. This is what’s called a retinal stroke, often resulting in vision loss.

“These symptoms can either be permanent, which would be a stroke, or they could be temporary, which is called a TIA or a transient ischemic attack. TIAs are often a precursor to stroke; therefore, if you have any of these symptoms, especially if they come and go, one must be aware that an impending stroke may occur. “You should not waste any time in coming to the hospital,” urges Dr. Eller. “I dare say, in the entire field of medicine, there is no other condition more time-sensitive than stroke.”

Treatment Options
Individuals can take measures to prevent their risk for carotid artery disease. The first preventative action is medical management to control blood pressure and cholesterol, manage diabetes, exercise, eat right and avoid smoking. Doing so significantly reduces the likelihood the disease will develop. Medications may need to be a part of these efforts.

If patients go beyond a certain threshold, there are more aggressive interventional options: open surgery, which is a procedure called carotid endarterectomy, and a more minimally invasive option called endovascular stenting.

“Both options work really well. The intervention piece of this, either by open surgery or by the endovascular route, work to reopen the vessel,” notes Dr. Eller.

Patients work with their team of physicians to determine which option is the best choice for their individual needs—whether the more conservative approach or surgical intervention.

“At Crouse, we are proud to say we have all the elements in place to provide very comprehensive, multidisciplinary care for patients suffering from vascular diseases in general, cerebrovascular diseases in particular,” says Dr. Eller. “We have a well-trained, well-experienced team of physicians, cerebrovascular surgeons and vascular surgeons. We provide comprehensive evaluations of what is the best treatment for any individual patient, including open surgery or carotid stenting.”

**To listen to Dr. Eller’s podcast about this topic, click here.

Crouse News is reported by members of our Communications Team.