Carotid artery disease in the neck and brain is like coronary artery disease in the heart. It occurs when plaque builds up in the carotid arteries, which supply oxygen-rich blood to the brain. If the arteries get blocked and the brain does not get enough oxygen, a stroke may occur. A stroke, or “brain attack,” is like a heart attack in the brain, and can cause death or permanent disability. It is the third largest killer in the United States.
Blood is delivered from the heart to the brain through four arteries: two carotid arteries in the front of your neck, and two smaller vertebral arteries in the back. You can feel the carotid arteries by pressing gently on either side of your windpipe. When you feel your pulse, those are the carotid arteries. Atherosclerosis occurs when fat and cholesterol deposits (“plaque”) build up in your arteries. Plaque slows the flow of blood to the brain (or, in the case of coronary artery disease, the heart). There are three ways this can lead to a stroke:
the plaque can severely narrow the arteries
a blood clot can become wedged in the artery
plaque from the carotid arteries can break off and block a smaller artery If the brain is denied oxygen for more than three hours, the damage can be permanent.
Risk Factors
If you have carotid artery disease, you probably have coronary artery disease as well. Both have similar risk factors:
high blood pressure
diabetes mellitus
high levels of “bad cholesterol”
smoking
family history of coronary or carotid artery disease
obesity
lack of exercise (sedentary lifestyle)Symptoms
Carotid artery disease often has no symptoms. But a transient ischemic attack (TIA, sometimes called a “mini-stroke”) is a warning that you might soon have a stroke. These are temporary episodes of stroke-like symptoms, which may last a few minutes or a few hours. Symptoms of TIA (or stroke) include:
headache
dizziness
tingling
confusion
numbness
facial droop
paralysisOther symptoms of carotid artery disease include:
weakness, paralysis, numbness or tingling on one side of your arm, leg or face on one side of your body
loss of eyesight or blurry eyesight
sudden, severe, unexplainable headacheDiagnosis
There are a variety of tools for diagnosing carotid artery disease. Your doctor may be able to diagnose it using a stethoscope during a normal checkup. But this method can produce false negatives, meaning you may have the disease even if your doctor does not detect it. It can also make your blockage seem more severe than it really is.
There are other diagnostic tools:
Doppler ultrasound imaging uses sound waves to check blood flow and measure artery thickness.
Magnetic Resonance Angiography uses magnetic fields to generate a picture of your arteries.
Oculoplethysmography measures the arteries’ pulsation
Various methods can be used to x-ray the carotid arteries.
If you have a stroke, go to the emergency room immediately. With modern treatments, many people who are treated early for their stroke can have an almost complete recovery.Treatment options for carotid artery disease include lifestyle changes, medication and surgery. You should also find out if you have heart rhythm or circulation problems that could increase your risk, and treat those problems. Quitting smoking, lowering the amount of cholesterol and salt in your diet, exercising and losing weight can help. Limit your alcohol intake to one to two drinks a day for men and one drink a day for women. You can also take blood thinning medications or aspirin. If you have to take these medications, you will probably take them for the rest of your life. There are also procedures and surgery to open your arteries. For carotid angioplasty, a balloon catheter is used to flatten plaque blockages, and a small metal device called a stent is placed in the artery to keep it open. Carotid endarterectomy actually removes the plaque. The surgeon makes an incision in the neck, at the location of the blockage. A tube is temporarily inserted to reroute blood flow while the surgeon removes the plaque.
