2022 Western Medical Research Conference
Carotid Stenosis
Content
The goal of treatment for carotid artery disease is to reduce the possibility of TIA or stroke, or to prevent the recurrence of a stroke.
Medical Therapy - Medications such as aspirin, other antiplatelets agents (like Plavix), diabetic medications, and medications that lower cholesterol and blood pressure are commonly prescribed when the degree of narrowing is less than 60 percent. Smoking cessation, exercise, and a healthy diet is also important for managing carotid artery disease and preventing further narrowing.
Carotid Endarterectomy - For patients with significant carotid artery narrowing with or without stroke-like symptoms, surgery may be recommended. Carotid Endarterectomy surgery involves exposing the carotid artery in the neck, clamping the artery above and below the plaque buildup, opening up the artery with a knife while it is clamped and directly removing the plaque (Figure 2).
Carotid Stenting - Alternatively, for select patients, carotid angioplasty and stenting, may be recommended. This procedure involves placing a self-expanding stent in the artery at the site of the narrowing and the stent expands holding the artery open (Figure 3), thereby, reducing the risk of future strokes.
The Role Of Imaging In Diagnosis And Management
Stroke is a major cause of morbidity and mortality, with carotid disease representing an important contributory risk factor. This book offers comprehensive coverage of the pathogenesis and management of carotid disease with specific focus on the role imaging has to play in the early recognition of symptomatic and asymptomatic disease as well as the treatment of the developed condition. Technological advances in imaging modalities now allow detailed analysis of the disease progression, the prediction of critical events leading to a stroke, as well as the identification of the most effective surgical or other interventional treatments. This book should be read by neurologists, cardiologists, vascular surgeons, neurosurgeons and radiologists involved in the care of patients with carotid disease, and also by researchers involved in the development of new therapeutic techniques and drugs.Stroke is a major cause of morbidity and mortality, with carotid disease representing an important contributory risk factor. This book offers comprehensive coverage of the pathogenesis and management of carotid disease with specific focus on the role imaging has to play in the early recognition of symptomatic and asymptomatic disease as well as the treatment of the developed condition. It discusses the technological advances in imaging modalities which now allow detailed analysis of the disease progression, the prediction of critical events leading to a stroke, as well as the identification of the most effective surgical or other interventional treatments. Highly illustrated throughout with leading expert contributors, this book should be read by neurologists, cardiologists, vascular surgeons, neurosurgeons and radiologists involved in the care of patients with carotid disease, and also by researchers involved in the development of new therapeutic techniques and drugs.
'This is a very useful book. … an excellent monograph on a rapidly developing topic which it covers well.' Neuroradiology
'Another quality of the book is the adequate balance among the 35 chapters. The editors should be praised for producing a pleasing consistency of style. Production is excellent with helpful tables and good illustrations. A welcome list of abbreviations used through the work can be found at the beginning of the book.' Pediatric Radiology
'This book provides a comprehensive review of the current state of imaging both for the assessment of carotid stenosis, and particularly of the methods and rationale for plaque imaging. The reviews are well-written and up to date with comprehensive references. … I think this book is of particular value to departments and practitioners that have a large carotid practice, particularly those who want to develop or research imaging of plaque morphology.' Clinical Radiology
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× Product detailsDedicationAbbreviationsIntroduction Henry J. M. Barnett1. Pathology of carotid artery atherosclerotic disease Renu Virmani, Allen Burke, Elena Ladich and Frank Kolodgie2. Epidemiology of carotid artery atherosclerosis Christopher O'Donnell3. Genetics of carotid atherosclerosis Stephen Rich and Donna Arnett4. Haematological processes in emboli formation Alison Goodall and Greg McMahon5. Medical treatment for carotid stenosis Matthew Giles and Peter Rothwell6. Surgical management of symptomatic carotid disease: carotid endarterectomy and extracranial-intracranial bypass Jonathan Brisman and Marc Mayberg7. Surgery for asymptomatic carotid stenosis Stella Vig and Alison Halliday8. Interventional management of carotid disease Andrew Clifton9. Conventional carotid Doppler ultrasound Gregory Moneta10. Conventional digital subtraction angiography for carotid disease Jean Marie U-King-Im and Jonathan Gillard11. Magnetic resonance angiography of the carotid artery Martin Graves, Jean Marie U-King-Im and Jonathan Gillard12. Computed tomographic angiography of carotid artery stenosis Paul Nederkoorn, Charles Majoie and J. Stam13. Cost-effectiveness analysis for carotid imaging Jean Marie U-King-Im, William Hollingworth and Jonathan Gillard14. Morphological plaque imaging Chun Yuan and Tom Hatsukami15. CT of the plaque Thomas de Weert, Mohamed Ouhlous, Marc van Sambeek and Aad van der Lugt16. Assessment of carotid disease with ultrasound Stephen Meairs17. Intravascular ultrasound Gaston Rodriguez-Granillo and Patrick Serruys18. Image post-processing William Kerwin, Dongxiang Xu and Fei Liu19. Nuclear imaging for the assessment of patients with carotid artery atherosclerosis John Davies and Peter Weissberg20. USPIO - enhanced MR imaging of carotid atheroma Simon Howarth, Tjun Tang, Martin Graves, Rikin Trivedi, J. Harle and Jonathan Gillard21. Gadolinium enhanced plaque imaging William Kerwin22. Carotid magnetic resonance direct thrombus imaging Alan Moody23. The proximal carotid arteries - image-based computational modelling X. Xu and Nick Wood24. Mechanical image analysis using finite element method Tjun Tang, Chun Yang and Chun Yuan25. Transcranial Doppler monitoring Michael Gaunt26. MR and CT perfusion Jeroen van der Grond and Matthias van Osch27. Near infrared spectroscopy in carotid endarterectomy Pippa Al-Rawi and Peter Kirkpatrick28. Single photon emission computed tomography (SPECT) Kuniaki Ogasawara29. Monitoring carotid interventions with Xenon CT H. Yonas and A. Carlson30. Vascular imaging and the clinical development of new pharmaceuticals James Revkin and David Lester31. Monitoring pharmaceutical interventions with conventional ultrasound (IMT) John Crouse32. Monitoring pharmaceutical interventions with IVUS Stephen Nicholls, Steven Nissen and Murat Tuzcu33. Monitoring of pharmaceutical interventions: MR plaque imaging Tom Hatsukami34. Molecular imaging of carotid artery disease James Rudd, Michael Lipinski, Fabien Hyafil and Zahi Fayad35. Future technical developments Brian Rutt and John Ronald.
Look InsideJonathan Gillard, University of CambridgeJonathan Gillard is a Reader in Neuroradiology in the University of Cambridge, and an Honorary Consultant Neuroradiologist at Addenbrooke's Hospital.
Martin Graves, University of CambridgeMartin Graves is Consultant Clinical Scientist in the Departments of Radiology and Medical Physics at Cambridge University Hospitals NHS Foundation Trust.
Thomas Hatsukami, University of WashingtonThomas Hatsukami is a Professor of Vascular Surgery at the University of Washington School of Medicine in Seattle, Washington.
Chun Yuan, University of WashingtonChun Yuan is a Professor of Radiology at the University of Washington, Seattle, Washington.
ContributorsHenry J. M. Barnett, Renu Virmani, Allen Burke, Elena Ladich, Frank Kolodgie, Christopher O'Donnell, Stephen Rich, Donna Arnett, Alison Goodall, Greg McMahon, Matthew Giles, Peter Rothwell, Jonathan Brisman, Marc Mayberg, Andrew Clifton, Gregory Moneta, Jean Marie U-King-Im, Jonathan Gillard, Martin Graves, Paul Nederkoorn, Charles Majoie, J. Stam, William Hollingworth, Jonathan Gillard, Chun Yuan, Tom Hatsukami, Thomas de Weert, Mohamed Ouhlous, Marc van Sambeek, Aad van der Lugt, Stephen Meairs, Gaston Rodriguez-Granillo, Patrick Serruys, William Kerwin, Dongxiang Xu, Fei Liu, John Davies, Peter Weissberg, Simon Howarth, TjunTang, Martin Graves, Rikin Trivedi, J Harle, Jonathan Gillard, William Kerwin, Alan Moody, X. Xu, Nick Wood, Chun Yang, Michael Gaunt, Jeroen van der Grond, Matthias van Osch, Pippa Al-Rawi, Peter Kirkpatrick, Kuniaki Ogasawara, H. Yonas, A Carlson, James Revkin, David Lester, John Crouse, Stephen Nicholls, Steven Nissen, Murat Tuzcu, Tom Hatsukami, James Rudd, Michael Lipinski, Fabien Hyafil, Zahi Fayad, Brian Rutt, John Ronald
What Causes Carotid Artery Neck Pain?
A few conditions affecting the carotid arteries can lead to neck pain. For instance, some people experience neck pain due to inflammation of the blood vessels. This is known as carotidynia.
Carotid artery dissection can also cause pain in the neck. This condition occurs due to a tear in the artery, sometimes due to an injury. It is a medical emergency and can lead to a stroke.
However, neck pain can also occur for other reasons, such as sleeping awkwardly, sitting for too long, or pinching a nerve. If a person is in any doubt, they should call a doctor.
Read on to learn more about carotid artery neck pain, including its causes and treatments.
There are several reasons why the carotid arteries, or the area around them, might hurt.
The carotid arteries are a pair of blood vessels at the front of the neck. They supply oxygen-rich blood to the front of the brain. This region of the brain manages thought, speech, personality, and the ability to feel physical sensations and move.
If there is pain in the carotid arteries themselves, this could be due to carotidynia, which is an inflammatory condition, or carotid artery dissection, which is a tear in the inner layer of the arteries.
However, pain in the region of the carotid arteries does not necessarily come from the arteries. A person could have neck pain for other reasons, such as:
It is important to speak with a doctor if a person experiences neck pain that could be in the carotid arteries. It is impossible to self-diagnose the cause, so a doctor will need to investigate.
If a person has any of the following signs of stroke, call 911 immediately:
Below is more information on the potential causes of carotid artery pain.
Carotid artery dissection is a tear in the inner layer of a carotid artery. This can cause blood to leak into the other layers of the artery and may restrict blood flow to the brain, causing a stroke.
Carotid artery dissection is the most common cause of stroke in people younger than 40 and causes 2.5% of strokes overall.
The condition may occur due to trauma, such as a car accident. It also more commonly occurs in people with connective tissue disorders, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia. However, the cause is unknown in most cases.
The symptoms of carotid artery dissection vary significantly between individuals, from no symptoms to severe symptoms. Some potential signs may include:
Doctors may treat carotid artery dissection with blood-thinning medications or a stent, which is a tube that supports the inside of the artery. The exact treatment will depend on whether:
A person has the best chance of fully recovering if they receive medical attention immediately.
Carotidynia is a rare inflammatory disorder of the blood vessels that causes pain in the face and neck. Doctors sometimes refer to carotidynia as Fay syndrome or transient perivascular inflammation of the carotid artery (TIPIC) syndrome.
One study from 2017 reported that carotidynia causes 2.8% of acute neck pain cases. The condition has no known cause, but it is linked to tenderness at the point where the two branches of the carotid artery divide. In rare cases, the condition may be due to nose and throat cancer, chemotherapy, or high altitude travel.
People usually only experience carotidynia symptoms on one side of their head. The symptoms may get worse when they:
Pain episodes can last 7–14 days and tend to come back every 1–6 months. Because the pain episodes often go away on their own, doctors tend to recommend rest and pain-relieving medications, such as nonsteroidal anti-inflammatory drugs, to treat the symptoms.
If symptoms do not clear up, a doctor may prescribe a short course of corticosteroids or another medication.
Some people may wonder if pain around the carotid arteries means they have a blockage due to carotid artery disease. However, pain is not typically a symptom of this.
Carotid artery disease occurs when plaque builds up inside blood vessels, causing them to narrow. This allows less blood to flow to the brain. Often, carotid artery disease does not cause symptoms until it is severe enough to cause a stroke.
Doctors may be able to detect carotid artery disease when carrying out other tests. They may hear a "whooshing" sound when listening to the artery using a stethoscope or see signs of carotid artery disease on medical scans.
If a person gets an early diagnosis, treatment involves taking steps to lower the risk of stroke. This may include:
Carotid artery neck pain may be due to conditions that directly affect the carotid arteries, such as carotidynia. This is a rare disorder without a clear cause.
Another explanation is carotid artery dissection, a serious condition that can occur after an injury. It is a medical emergency that can cause a stroke. However, other conditions can cause pain at the front of the neck in the same area as the carotid artery.
If a person has severe symptoms that could be signs of a stroke, it is important to seek emergency help right away. Otherwise, it is best to speak with a doctor about this symptom so they can determine the cause.
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