Carotid Artery Disease

Plaques in the arteries leading to the brain can reduce blood flow and lead to strokes—a leading cause of death and disability in the United States.

What is carotid artery disease?

Carotid artery disease involves the build-up of plaque (atherosclerosis) in the two largest blood vessels to the brain—one on each side of the neck.

This plaque causes the arteries to harden and narrow, reducing the flow of oxygen-rich blood to the brain. The plaque can also rupture and cause a stroke, which may lead to serious disability and even death.

What are the symptoms of carotid artery disease?

Unlike other conditions caused by atherosclerosis, there are usually no symptoms for carotid artery disease until a stroke or “mini-stroke” (transient ischemic attack or TIA) occurs. Signs and symptoms of a stroke include:

  • Sudden tingling, numbness, or weakness, especially in the face or limbs, often on one side of the body
  • Sudden trouble seeing with one or both eyes
  • Sudden trouble speaking or understanding speech
  • Sudden loss of balance or dizziness
  • Sudden, severe headache with no known cause

These signs and symptoms require emergency medical care, even if the symptoms last only for a short time, as the person may be at risk for a more serious stroke.

How is carotid artery disease diagnosed?

Physicians use a variety of tests to diagnose carotid artery disease, including:

  • Physical exam and medical history – to determine risk factors
  • Carotid ultrasound – to determine if plaque has narrowed the carotid arteries
  • Carotid angiography – involving an injection of contrast dye into a vein to highlight the carotid artery on x-rays and determine if a blockage is present
  • Magnetic Resonance Angiography (MRA) – using magnetic imaging to check for blockages
  • CT Angiography – using two- or three-dimensional images of the carotid arteries to check for plaque blockages

What causes carotid artery disease?

Carotid artery disease is caused by a build-up of plaque—fat, cholesterol, calcium, and other substances—on the walls of the two main blood vessels in the neck that supply the brain with blood. The cause of this build-up is not yet fully understood, but it appears to originate and progress from damage to the artery due to a combination of factors, such as:

  • High blood pressure
  • High levels of “bad” (LDL) cholesterol
  • Low levels of “good” (HDL) cholesterol
  • Smoking
  • High blood sugar due to insulin resistance or diabetes
  • Obesity
  • Inflammation of the artery wall
  • Sedentary lifestyle and poor diet
  • Genetic factors or a family history of atherosclerosis

How is carotid artery disease treated?

For milder cases, treatment options may include lifestyle changes—such as losing weight, eating healthy foods, reducing salt, exercising, and quitting smoking—and medication to lower cholesterol and blood pressure. A daily aspirin may also be prescribed to prevent blood clots.

For more serious blockages, treatment options include:

  • Carotid angioplasty and stenting – inserting a catheter into the blocked artery and inflating a balloon to compress the plaque against the walls of the artery and restore blood flow; a mesh tube (stent) may be placed to keep the artery open
  • Carotid endarterectomy – a surgical procedure to remove the plaque or place a bypass graft

Carotid endarterectomy is most commonly used to remove plaque from the carotid arteries; carotid angioplasty and stenting are usually reserved for patients who cannot undergo surgery, and the procedure is still considered to be under investigation for effectiveness.

Current atherectomy devices cannot treat carotid artery disease. Cardio Flow is working to provide physicians with a new, minimally-invasive treatment option for this serious condition.

How many people are affected by carotid artery disease?

Stroke is one of the leading causes of disability and death, with some 33 million people affected worldwide each year. In the United States, stroke is the fifth leading cause of death, with carotid artery disease estimated to cause approximately 15% of strokes, making the disease one of the major causes of permanent disability or death.

References:

Carotid Artery Disease,” Mayo Clinic, July 19, 2014, accessed online 01.07.16.
What is Carotid Artery Disease?,” NIH: National Heart, Lung, and Blood Institute, updated October 29, 2015; accessed online 01.07.16.
Bruce Perler, MD, “About Carotid Artery Disease and Stroke – Prevention and Treatment [Transcript],” Johns Hopkins Medicine, accessed online 01.07.16.
Impact of Stroke (Stroke Statistics),” American Stroke Association, updated July 22, 2015, accessed online 01.07.16.
Leading Causes of Death,” Centers for Disease Control and Prevention 2013, accessed online 01.07.16.
Matthew L. Flaherty, MD, “Carotid Artery Stenosis as a Cause of Stroke,” Neuroepidemiology, 2013; 40(1), 36-41, accessed online via US National Library of Medicine, 01.07.16.