The carotid arteries deliver blood to the brain. One artery is located on each side of the neck. When your doctor puts his or her hands on your neck to detect a pulse, he or she is feeling for one of your carotid artery.
Carotid artery disease (CAD) occurs when a blockage in one of these arteries decreases the blood flow to the brain. This can lead to stroke.
According to an article in the journal Circulation, an average of 750,000 people have a stroke every year in the United States. Most of these strokes are either caused by CAD or atrial fibrillation (Beckman, et al., 2006). The Vascular Disease Foundation reports that CAD causes more than half of all strokes in the United States (VDF).
Atherosclerosis can make the carotid arteries become narrower and less flexible over time. Atherosclerosis causes a buildup of cholesterol, fat, inflammatory cells, cellular waste, proteins, and calcium in the arteries. This buildup is called plaque.
CAD can also be the result of other diseases that cause arterial damage.
There are a number of conditions that can damage your arteries and put you at increased risk of CAD, including:
- High blood pressure (HBP) can weaken artery walls and make them susceptible to damage.
- High cholesterol is a major risk factor for atherosclerosis.
- Diabetes can affect the body’s ability to process blood sugar. It increases your risk of HBP and atherosclerosis.
- Obesity increases your risk of diabetes, HBP, and atherosclerosis.
- Physical inactivity contributes to HBP, diabetes, and obesity.
- Smoking can irritate the lining of the arteries. It can also increase your heart rate and blood pressure.
- Older age makes your arteries stiffer and more susceptible to damage.
A family history of atherosclerosis is also associated with increased CAD risk
Early CAD rarely causes symptoms. Symptoms are only likely to appear once one of your carotid arteries has become nearly or fully blocked. At that point, you are at high risk for a transient ischemic attack (TIA) or a stroke. A TIA is also known as a mini-stroke, since it causes stroke symptoms that only last from a few minutes to a few hours. These symptoms include:
- sudden weakness or numbness in face, arms or legs (usually on one side of the body)
- trouble speaking or understanding
- sudden vision problems in one or both eyes
- sudden severe headache with no apparent reason
- numbness and heaviness in limbs
- one side of face becomes droopy
Seek medical attention immediately if you experience any of these symptoms. They could be the sign of a medical emergency.
If you fall into a high-risk group for CAD, your doctor will want to test you for early signs of damage. You are considered high risk if you have:
- high blood pressure
- high cholesterol
- a family history of atherosclerosis
You may also be considered high risk if you are obese, smoke, or live a sedentary life.
There are a number of tests that can be used to detect CAD.
Your doctor will listen to the arteries in your neck for a swishing sound called a bruit. This is a signal that there is narrowing in the vessels. Your strength, memory, and speech may also be tested.
This non-invasive test uses sound waves to measure the flow and pressure of blood in your vessels.
Computerized Tomography/Angiography (CTA)
This is a way to take X-ray images of your vessels. First a dye called contrast is placed in the vessels. Then the CTA scan takes pictures from several angles.
Head Computerized Tomography (CT Scan)
This procedure takes pictures of your brain tissue to check for any bleeding or abnormalities.
Magnetic Resonance Angiography (MRA)
This test also uses contrast to highlight neck and brain arteries. Then 3-D images are taken using a high-powered magnet.
Magnetic Resonance Imaging (MRI)
This test takes detailed images of brain tissue. However, unlike an MRA, it does not use contrast.
In this test, your doctor will insert a thin, flexible tube called a catheter into your carotid artery. Dye will be injected. Then an X-ray will be taken to view any abnormalities. This test is more invasive than the other forms of imaging.
The main potential complication of CAD is a stroke. A stroke occurs when the blood flow to the brain is interrupted. This can lead to loss of brain function or even death.
There are several ways that CAD can cause a stroke:
- narrowed carotid arteries may not supply enough blood to the brain
- a piece of plaque can break off and lodge in one of the smaller arteries of the brain, blocking blood flow
- blood clots can form in the carotid artery, blocking blood flow
- blood clots can break off from inside the artery and block a smaller artery in the brain
Your treatment plan will be based on your symptoms and whether or not you’ve experienced a stroke.
If you are diagnosed before you have a stroke, doctors will suggest that you make preventative lifestyle changes. These include:
- stopping smoking
- exercising regularly
- eating healthy food
- managing any chronic conditions
- taking medications as prescribed
Treatment is more invasive if your CAD is found after a stroke. Your doctor may need to open the artery to remove the blockage. This can be done in two ways:
Carotid endarterctomy is the most common form of surgery for severe CAD. After giving you a local or general anesthesia, your doctor will make a cut on the front of your neck. Your carotid artery will be opened and any blockages will be removed. The artery will then be stitched closed. This is a relatively low-risk procedure that can have a lasting effect on preventing strokes.
Carotid artery stents are used if a blockage is inconveniently located. They may also be used for large blockages or when you have other health problems. In this procedure, a balloon is used to widen a narrowed section of artery. Then a stent—a small wire coil—is placed inside to keep the artery open.
Your long-term outlook will depend on the extent of your disease. However, there are things you can do to improve your health. These include:
- regular blood pressure checks
- checking blood sugar and cholesterol levels one to two times a year
- yearly carotid Doppler ultrasounds (for prior stroke victims) to show blood flow through the carotid arteries
- regular check-ups
There are steps you can take to decrease your chances of developing CAD.
- Quitting smoking can reduce your stroke risk to that of a non-smoker within a few years.
- Limiting cholesterol and fat will reduce your risk of atherosclerosis.
- Getting regular exercise helps lower blood pressure, increase good cholesterol levels, and improve heart health.
- Reducing alcohol consumption may improve heart health.
- Keeping a healthy weight can reduce your risk of developing CAD.
Managing diabetes and other chronic health conditions is also a great way to reduce the risk of long-term complications, like CAD or stroke. Talk to your doctor about the best way to maintain your heart and vessel health.