Carotid Artery Disease

Causes of Carotid Diseases

A substance called plaque (fat and cholesterol deposits on the inside blood vessel walls) accumulates inside your arteries as you age. When plague builds up in your carotid arteries, this can be very dangerous since these are the main arteries in your neck that supply blood to your brain. If too much plaque builds up, the carotid arteries will narrow (called carotid stenosis). Carotid stenosis can cause abnormal blood flow, leading to blood clots. The clots can then break off and travel to the brain, causing a minor or major stroke.

Of adults 60 and older, up to 3% have carotid artery disease. Aging, high blood pressure, smoking, diabetes, high cholesterol and heart disease increase your risk.

Types of Carotid Diseases

• Carotid artery disease is a blockage or narrowing in the arteries that supply blood flow to the brain. This can lead to a transient ischemic attack (TIA) or stroke.
• Carotid artery dissection starts off as a tear in one layer of the artery wall. Blood leaks through this tear and spreads between the layers of the wall.
• Carotid body tumors are growths around the carotid artery within the nervous tissue.
• Carotid artery aneurysm is a bulge in the wall of your carotid artery. The bulge results from weakness in that area of the artery wall.

Symptoms of Carotid Diseases

Carotid stenosis is responsible for as many as one-third of all strokes. Stroke is one of the top five leading causes of death in the United States, and more than 700,000 people have strokes every year. During middle age, men are more likely to have a stroke than women, but the gender ratio reverses for people 85 and older, when women are more likely to experience a stroke.

Diagnosis of Carotid Diseases

There are a few tests that can detect carotid diseases.

• Ultrasound can assess blood flow and pressure in the carotid arteries.
• Angiogram provides images of blood flow in the carotid arteries.
• Magnetic resonance imaging (MRI) helps to trace evidence of stroke or other irregularities.

Treatment of Carotid Diseases

• Upon initial examination, the carotid ultrasound is used for diagnosis. The test involves a high-frequency sound to create images of the insides of two large arteries in your neck, so a cardiologist or vascular surgeon can review their structure and see any plaque buildup. Two ultrasound tests are performed simultaneously: The standard ultrasound provides information about the arteries’ structure, and the Doppler ultrasound focuses on blood flow. After diagnosis, regular carotid artery ultrasound tests are used to monitor the condition.
• Treatment varies based on disease progression. In milder cases, medications, such as blood thinners, are often prescribed to prevent clotting and stroke.
• In more advanced cases, carotid endarterectomy is used to remove a blockage. It is the most common treatment method and is relatively safe.
• In very severe cases, carotid artery stenting helps to increase blood flow inside the carotid artery. It is preferred for patients with severe blockage, though not all patients are candidates for stenting. It is FDA approved for symptomatic patients with more than a 60% blockage as well as asymptomatic patients with a blockage that is greater than 80%.

Lifestyle Management

• Smoking cessation
• Daily exercise
• Weight loss
• Medical management of risk factor conditions, such as diabetes, high cholesterol and high blood pressure

Make an Appointment

If you or someone you care for is experiencing carotid disease symptoms, we encourage you to make an appointment with one of WakeMed’s experienced vascular specialists.

• Request a Heart and Vascular Appointment
• Refer a Patient (Physicians)