Carotid Artery Problems

What are carotid artery problems and why are they important?

The carotid artery carries blood to your brain from the aorta which is the main vessel carrying blood from the heart to your body. If the carotid artery becomes diseased, you may be at risk for suffering a stroke. Although there are several types of diseases which can affect the carotid arteries, arteriosclerosis is the most common. The common carotid artery, a branch of the aorta, comes up out of your chest into your neck where it divides into the external carotid artery which goes to your face and scalp. The other division, called the internal carotid artery, goes to your brain and it is the first part of this artery which most commonly develops arteriosclerosis putting you at risk for a stroke. We have been asked to evaluate your carotid arteries to determine whether you may be at risk for a stroke.

How does arteriosclerosis affect the carotid artery?

At birth, the lining of your arteries is smooth and glistening, however, as you age, deposits of cholesterol, calcium and fibrous tissue called plaque may be deposited inside the artery. A piece of this plaque can break off and sail into your brain, plugging a small artery and causing a stroke. Sometimes, the plaque slowly builds up to the point where the blood flow is restricted and your brain does not get enough blood flow to function. This too can cause a stroke. Small degrees of blockage are usually not worrisome but if you have had a stroke or a “mini-stroke,” a narrowing of the carotid artery may be the cause. In addition, if the plaque causes a significant narrowing of the internal carotid artery (the one going to your brain) we feel that you may be at risk for having a stroke even though you may not have had a neurological problem.

How will I know if I have carotid artery problems?

Unfortunately, strokes can occur out of the blue but sometimes there will be a warning that the internal carotid artery has a significant plaque. A symptom may be an episode of abnormal vision in one eye, an episode of numbness or weakness affecting one side of your face. You might notice transient slurring or loss of speech. In addition, one of your extremities may become numb, weak or difficult to control. If you experience anyone of these signs, call your doctor or go directly to the emergency room. Prompt treatment can prevent a stroke or rescue you from the effects of one.

What tests are used to examine the carotid artery for plaque?

Just as a water hose makes a noise when it becomes kinked, a narrowed carotid artery can make a noise (bruit) which can be heard by your physician by listening to your neck with a stethoscope. Pressing your thumb over the open end of a hose will increase the speed of water. Similarly, the speed of blood increases as the internal carotid artery becomes increasingly narrowed. Ultrasound, often used to see babies before they are born, is often used to measure the speed of blood in the carotid arteries to determine the degree of narrowing and to look for plaque buildup. Not only is ultrasound accurate but it is the safest, least invasive and least expensive test used to check the carotid artery. There is no discomfort and needles are not required. There are a number of other tests that can be ordered if additional information is needed such as CT or MR scans. Occasionally, if even more information is necessary, a carotid angiogram may be necessary. It consists of injecting an agent, visible with X-rays, into the neck arteries. These tests are increasingly expensive, more invasive and slightly more risky.

If I have plaque in my carotid artery, how can I prevent it from getting worse?

Arteriosclerosis is a slowly progressive arterial disease but the rate of progression can be influenced by our habits. The most important advice we can give you is to STOP SMOKING even though it’s hard to do. Eating less fat and reducing your cholesterol are helpful but are not as beneficial as giving up your smoking habit. Diabetics should control their glucose levels closely. Blood pressure medication, cholesterol lowering drugs and aspirin are commonly used to reduce the risk of arteriosclerosis which can cause strokes or heart attacks. Unfortunately, your physicians cannot change genes that may predispose you to arteriosclerosis but we can reduce your risk of stroke by fixing narrowed internal carotid arteries.

If my carotid artery needs treatment, how is it done?

Hopefully, with medication and life-style changes your carotid artery disease will never need treatment but if it does, it is treated very carefully, with very little risk, with little discomfort and with the expectation of a full and rapid recovery. Most commonly, surgery is performed but stents are sometimes used. If surgery is necessary, a small skin incision in the neck allows your surgeon to open the artery and clean out all the plaque while maintaining blood flow to the brain. The procedure is like having a “roto-rooter” performed but with great care to prevent any particles going into your brain. Alternatively, a stent may be used to reduce the narrowing by pushing the plaque out of the way.

This is general information and we encourage a full and thorough discussion with you and your family about your carotid artery problem.