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Carotid Stenosis

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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.

Carotid Artery Disease

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Carotid artery disease may be asymptomatic (without symptoms) or symptomatic (with symptoms). Asymptomatic carotid disease is the presence of a significant amount of atherosclerotic build-up without obstructing enough blood flow to cause symptoms. However, a sufficiently tight stenosis will not always cause symptoms. Symptomatic carotid artery disease may result in either a transient ischemic attack (TIA) and/or a stroke (brain attack).

A transient ischemic attack (TIA) is a sudden or a temporary loss of blood flow to an area of the brain, usually lasting a few minutes to one hour. Symptoms usually go away entirely within 24 hours, with complete recovery. Symptoms of a TIA may include, but are not limited to, the following:

Sudden weakness or clumsiness of an arm and/or leg on one side of the body

Sudden paralysis (inability to move) of an arm and/or leg on one side of the body

Loss of coordination or movement

Confusion, dizziness, fainting, and/or headache

Numbness or loss of sensation (feeling) in the face

Numbness or loss of sensation in an arm and/or leg

Temporary loss of vision or blurred vision

Inability to speak clearly or slurred speech

TIA may be related to severe narrowing or blockage or from small pieces of an atherosclerotic plaque breaking off, traveling through the bloodstream, and lodging in small blood vessels in the brain. With TIA, there is rarely permanent brain damage.

Call for medical help immediately if you suspect a person is having a TIA, as it may be a warning sign that a stroke is about to occur. Not all strokes, however, are preceded by TIAs.

Stroke is another indicator of carotid artery disease. The symptoms of a stroke are the same as for a TIA. A stroke is loss of blood flow (ischemia) to the brain that continues long enough to cause permanent brain damage. Brain cells begin to die after just a few minutes without oxygen. The area of dead cells in tissues is called an infarct.

The area of the brain that suffered the loss of blood flow will determine what the physical or mental disability may be. This may include impaired ability with movement, speech, thinking and memory, bowel and bladder function, eating, emotional control, and other vital body functions. Recovery from the specific ability affected depends on the size and location of the stroke. A stroke may result in problems such as weakness in an arm or leg or may cause paralysis, loss of speech, or even death.

The symptoms of carotid artery disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Endovascular Treatment Of Vertebral Artery Stenosis

Competing interests

L. N. Hopkins has received research grants from Abbott Vascular, Boston Scientific, Cordis, ev3, and Toshiba. He has received Speaker's Bureau fees from Abbott Vascular and honoraria from Bard, Boston Scientific, Cordis, Complete Conference Management, Cleveland Clinic, and the Society for Cardiac Angiography and Interventions. He has a financial interest in AccessClosure, Boston Scientific, and Micrus and is a Consultant/member of the Advisory Board for Abbott Vascular, Access Closure, Bard, Boston Scientific, Cordis, Gore, Lumen Biomedical, Micrus, and Toshiba. Dr. Hopkins is also a Conference Director for Nurcon Conferences/Strategic Medical Seminars. M. J. Binning declares no competing interests.

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