Carotid Artery Disease

What is Carotid Artery Disease?

Carotid artery disease occurs when the carotid arteries – which carry blood from the aorta to the brain through the neck – become narrowed or blocked. The blockage may affect one or both of the carotid arteries. Narrowing or a blockage in the carotid artery is usually caused by the buildup of plaque in the arteries. This plaque is a result of a condition known as hardening of the arteries (atherosclerosis). Sometimes, this atherosclerotic plaque can lead to a stroke when a piece of the plaque breaks off and travels through the artery into the brain, blocking the blood flow to that area of the brain.

Causes

• Hardening of the arteries (atherosclerosis)
• Carotid aneurysm disease
• Carotid artery dissection
• Fibromuscular dysplasia (abnormal development of the lining in the walls of your the arteries)

Risk Factors

• Family history of atherosclerosis
• High cholesterol
• Smoking
• Diabetes
• High blood pressure

What are the Symptoms?

Symptoms may not appear during the early formation of carotid artery disease, and the first symptoms may be a stroke or warning signs of a stroke, known as a transient ischemic attack (TIA). Symptoms include:

• Feeling weak, numb or unable to move a certain body part
• Blurred or fuzzy vision, or partial or complete vision loss
• Having trouble talking or understanding others
• Dizziness, loss of balance or trouble walking
• A very painful headache

How is Carotid Artery Disease Diagnosed?

• Ultrasound: The most common test for detecting carotid artery disease is a painless test, where a small ultrasound probe is held to the neck. The ultrasound's high-frequency sound waves provide the doctor with a picture of the blood flow in the carotid arteries and whether there is any narrowing or blockage.
• Computed Tomography (CT) scan and CT Angiography: X-ray views of the neck and brain are taken to determine if there are any areas with poor blood flow or narrow arteries. Patients are injected with a dye that will help make blood vessels visible on the scan.
• Magnetic resonance angiography (MRA): Radio waves and magnetic fields are used to show areas of poor blood flow. Patients may be injected with a contrast material – similar to a dye – to make blood vessels more visible.
• Angiography: A dye is injected into the arteries through a catheter (usually inserted through a leg artery), and an X-ray is taken to show how blood flows through the arteries and whether any arteries are narrowed or blocked.

Treatment at UVA's Heart and Vascular Center

• Carotid endarterectomy (CEA): CEA is a surgical procedure where the plaque causing the narrowing or blockage in the carotid artery is removed, opening the carotid artery and improving blood flow. UVA performs about 120 CEAs each year. Research studies have shown that patient outcomes are better at hospitals that perform more than 100 CEAs annually.
• Carotid angioplasty and stenting: If a patient is unable to undergo a CEA for any reason – such as having plaque that can't be accessed surgically or being unable to undergo general anesthesia – another option is an angioplasty and stenting procedure. In this procedure, a surgeon inserts a catheter with a balloon on its tip and runs it to the area of the carotid artery that is blocked or narrowed. The balloon is inflated, pushing the plaque to the artery walls and opening up the artery. A small metal scaffolding called a stent is then inserted to keep the artery open.