Carotid Artery Disease Treatment
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Stroke-like symptoms, like dizziness, weakness on one side of your body, or problems seeing straight are definite causes of alarm. These could be signs you have carotid artery disease.
Carotid artery disease happens when one or both of your carotid arteries become narrowed or blocked. The carotid arteries carry blood from the aorta through the neck to the brain.
Plaque buildup in the carotid arteries cuts off blood flow to the brain and is a major cause of stroke.
A stroke can also occur when:
- Plaque in the artery ruptures and blood cell fragments (platelets) clump together to form blood clots. These blood clots can partly or fully block a carotid artery.
- A piece of plaque or blood clot breaks away from the carotid artery wall, travels through the bloodstream, and gets stuck in one of the brain's smaller arteries, blocking blood flow.
Treating Carotid Artery Disease at UVA Health
At UVA Health, we can check if you have carotid artery disease by using these tests:
- Ultrasound
- Computed tomography (CT) scan
- Magnetic resonance angiography (MRA)
- Angiography
If you do have it, we can work with you to choose the right treatment.
If the blockage isn't too bad, you may need medication or some heart-healthy lifestyle changes. For more severe blockages, you may need one of the following.
Carotid Endarterectomy (CEA)
UVA Health performs about 120 CEAs each year. Patients do better at hospitals that have more than 100 CEAs per year. CEA is a surgery that improves blood flow. Your surgeon opens your carotid artery and removes the plaque causing the problem.
Transfemoral Carotid Angioplasty & Stenting (TF-CAS)
TF-CAS may be the right procedure for you if you're not a good candidate for CEA or open surgery. Through this minimally invasive procedure, your surgeon places a tube in a thigh artery. A filter, placed beyond the carotid artery blockage, keeps fragments of plaque from traveling to your brain during the procedure.
Your surgeon puts a catheter with a balloon on its tip into your artery and threads it to the blocked or narrowed carotid artery. The balloon inflates and pushes the plaque to the artery walls to open it up. A stent helps keep the artery open.
Transcarotid Artery Revascularization (TCAR)
Transcarotid Artery Revascularization (TCAR) is a newer and less invasive technique that, in some cases, appears to reduce some of the risks of CEA and/or TF-CAS. It can be done under local or general anesthesia.
Your surgeon makes a small cut just above your collarbone and puts a tube into your carotid artery. The tube connects to a system that sends blood flow away from the brain to keep loose plaque from reaching your brain. The blood flows through the system, and a filter outside of the body captures any plaque that has come loose.
The filtered blood returns through a second tube in the upper leg. Once your surgeon places the stent and turns off blood flow reversal, your blood flow resumes in a normal direction.
Artery Blockage Increasing Risk of a Stroke
The carotid artery carries blood through the neck to the brain. When plaque builds up in the arteries, it increases the risk of a stroke. W. Darrin Clouse, MD, discusses the causes, symptoms, and treatment.
There are many different processes that can cause carotid artery disease, but by far the most overwhelmingly common is atherosclerosis, which is the same kind of biologic process that affects heart arteries, or might affect leg arteries, or other arteries throughout the body. Atherosclerosis is a process whereby a blockage occurs, and that blockage in the carotid artery can predispose someone to stroke. And so if we find the blockage in the carotid artery, the narrowing, it's called a stenosis. If we find that stenosis, and we're able to intervene, we reduce patient's long-term risk of stroke. Patients who are most likely to suffer from carotid artery disease are patients who have risk factors for atherosclerosis; high blood pressure, coronary artery disease, high cholesterol, family history of having artery problems. Generally, patients have the inability to move or feel their arm or leg. They may be unable to speak. They may have facial drooping. They also may have a condition of fleeting blindness. Those are all signs and symptoms of carotid artery disease that should be discussed with a doctor right away. Carotid artery disease can be treated in one of generally three ways; medical management, in which patients are put on antiplatelet therapy, which is aspirin, and we have some newer antiplatelet agents. Carotid artery stenosis has traditionally been treated in patients with significant stenosis by what's called carotid endarterectomy. Clamps are placed on the carotid artery to stop the blood flowing through the carotid artery, and the plaque, or atherosclerotic build-up, is cleaned from the carotid artery. That's what we have the most experience with. More recently with endoluminal, or what's called endovascular or less invasive techniques, carotid artery stenting has been performed. There's a newer treatment that involves carotid stenting, but it involves operating on the carotid artery in a way that's less invasive. The outcomes of this newer, what's called transcervical carotid artery stenting, or TCAR, are very similar to results of carotid endarterectomy, the traditional operation. And this is a novel way that the carotid artery is now treated in patients who might have a difficult operation, but now can have a less invasive operation.
Risk Factors for Carotid Artery Disease
Risk factors for this disease include:
- Diabetes
- Family history of atherosclerosis
- High blood pressure
- Lack of physical activity
- Metabolic syndrome
- Older age
- Obesity
- Smoking
- High cholesterol
- Unhealthy diet