Carotid Artery Disease -- December 22, 2008 -- Dr. Paul Fleser - NewsChannel5.com | Nashville News, Weather & Sports

Carotid Artery Disease -- December 22, 2008 -- Dr. Paul Fleser

Carotid artery disease is a condition in which plaque builds up inside the carotid arteries. You have two common carotid arteries-one on each side of your neck-that divide into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp and neck.

Carotid artery disease can be serious because it can cause a stroke, which occurs when blood flow to your brain is blocked. If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control. A stroke can cause lasting brain damage, long-term disability, paralysis or death. You have the best chance for full recovery if treatment to open a blocked artery is given within six hours of symptom onset. Ideally, treatment should be given within three hours of symptom onset.

  Causes

Carotid artery disease appears to start when damage occurs to the inner layers of the carotid arteries. Major factors that contribute to damage include:

• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged. Over time, the plaque may crack. Blood cells called platelets stick to the injured lining of the artery and may clump together to form blood clots. The buildup of plaque or blood clots can severely narrow or block the carotid arteries. This limits the flow of oxygen-rich blood to your brain and can cause a stroke.

Risk factors

Certain traits, conditions or habits may raise your risk for carotid artery disease. These conditions are known as risk factors. The more risk factors you have, the more likely you are to get the disease. You can control some, but not all, risk factors.

The major risk factors for carotid artery disease, listed below, also are the major risk factors for coronary artery disease and heart disease.

• Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called bad cholesterol) and low HDL cholesterol (sometimes called good cholesterol).
• High blood pressure.
• Smoking. This can damage and tighten blood vessels, raise cholesterol levels and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.
• Older age. As you get older, your risk for carotid artery disease goes up. About 1 percent of adults aged 50 to 59 have major plaque buildup in the carotid arteries. In contrast, 10 percent of adults aged 80 to 89 have this problem. Before age 75, the risk is greater in men than women. However, after age 75, the risk is higher in women.
• Insulin resistance. This condition occurs when the body can't use its own insulin properly. Insulin is a hormone that helps move blood sugar into cells where it's used. Insulin resistance may lead to diabetes.
• Diabetes. People who have diabetes are four times more likely to have carotid artery disease than people who don't have diabetes.
• Overweight or obesity. The most useful measure of overweight and obesity is the body mass index. BMI measures your weight in relation to your height and gives an estimate of your total body fat.
• Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raise your risk for stroke and other health problems, such as diabetes and heart disease.
• Lack of physical activity. Lack of activity can worsen other risk factors for carotid artery disease.
• Family history of atherosclerosis.

Having any of these risk factors doesn't mean you will get carotid artery disease. However, if you have one or more risk factors, you can take steps to help prevent the disease, including following a healthy lifestyle and taking medicines your doctor prescribes.

Symptoms

Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks the carotid arteries. Signs and symptoms may include a bruit, a transient ischemic attack or a stroke.

•·        Bruit

During a physical exam, your doctor may listen to your carotid arteries with a stethoscope. He or she may hear a whooshing sound called a bruit. This sound may suggest changed or reduced blood flow due to plaque. To find out more, your doctor may order tests. Not all people who have carotid artery disease have bruits.

•·        Transient Ischemic Attack

For some people, having a TIA, or "mini-stroke," is the first sign of carotid artery disease. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours. The symptoms may include:

• o Sudden weakness or numbness in the face or limbs, often on just one side of the body
• o The inability to move one or more of your limbs
• o Trouble speaking and understanding
• o Sudden trouble seeing in one or both eyes
• o Dizziness or loss of balance
• o A sudden, severe headache with no known cause
• o Even if the symptoms stop quickly, you should see a doctor right away. Call 9-1-1 (don't drive yourself to the hospital). It's important to get checked and to get treatment started within one hour of having symptoms.
• o A mini-stroke is a warning sign that you're at high risk of having a stroke. You shouldn't ignore these symptoms. About one-third of people who have mini-strokes will have strokes if they don't get treatment.
• o Although a mini-stroke may warn of a stroke, it doesn't predict when a stroke will happen. A stroke may occur days, weeks or even months after a mini-stroke. In about half of the cases of strokes that follow a TIA, the stroke occurs within one year.
• Stroke

Most people who have carotid artery disease don't have mini-strokes before they have strokes. The symptoms of stroke are the same as those of mini-stroke, but the results are not. A stroke can cause lasting brain damage, long-term disability, paralysis or even death.

Diagnosis

Your doctor will diagnose carotid artery disease based on your medical history and the results from a physical exam and tests. The following tests are common for diagnosing carotid artery disease. If you have symptoms of a mini-stroke or stroke, your doctor may use other tests as well.

• Carotid ultrasound is the most common test for diagnosing carotid artery disease. It's a painless, harmless test that uses sound waves to create pictures of the insides of your carotid arteries. This test can show whether plaque has narrowed your carotid arteries and how narrow they are. A standard carotid ultrasound shows the structure of your carotid arteries. A Doppler carotid ultrasound shows how blood moves through your blood vessels.
• Carotid angiography is a special type of x-ray. This test may be used if the ultrasound results are unclear or don't give your doctor enough information. For this test, your doctor will inject a contrast dye into a vein, most often in your leg. The dye travels to your carotid arteries and highlights them on x-ray pictures.
• Magnetic resonance angiography uses a large magnet and radio waves to take pictures of your carotid arteries. For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.
• CT angiography takes x-ray pictures of the body from many angles. A computer combines the pictures into two- and three-dimensional images. For this test, your doctor may give you contrast dye to highlight your carotid arteries on the pictures.

Treatment

Treatments for carotid artery disease may include lifestyle changes, medicines and medical procedures. The goals of treatment are to stop the disease from getting worse and to prevent a stroke. Your treatment will depend on your symptoms, how severe the disease is, and your age and overall health.

Lifestyle Changes

Making lifestyle changes often can help prevent carotid artery disease or keep it from getting worse. For some people, these changes may be the only treatment needed:

• Follow a healthy eating plan to prevent or lower high blood pressure and high blood cholesterol and to maintain a healthy weight.
• Increase your physical activity. Check with your doctor first to find out how much and what kinds of activity are safe for you.
• If you're overweight or obese, lose weight.
• If you smoke, quit. Avoid exposure to secondhand smoke.

Medicines

You may need medicines to treat diseases and conditions that damage the carotid arteries. High blood pressure, high blood cholesterol and diabetes can worsen carotid artery disease.

Procedures

You may need a medical procedure to treat carotid artery disease. Doctors use one of two methods to open narrowed or blocked carotid arteries.

•·        Carotid Endarterectomy

This treatment is mainly for people whose carotid arteries are blocked 50 percent or more. For the procedure, a surgeon will make a cut in your neck to reach the narrowed or blocked carotid artery. He or she will make a cut in the artery and remove the plaque inside. The artery and your neck will then be stitched up.

•·        Carotid Artery Angioplasty and Stenting

Doctors use angioplasty to widen the carotid arteries and restore blood flow to the brain. A thin tube with a balloon on the end is threaded through a blood vessel in your neck to the narrowed or blocked carotid artery. Once in place, the balloon is inflated to push the plaque outward against the wall of the artery. A stent (a small mesh tube) is then put in the artery to hold the plaque back and keep the artery open.