Carotid Disease
What are Carotid Disease?
The carotid arteries carry the majority of oxygen rich blood from the heart to the brain. Over time, these normally healthy, unobstructed arteries can narrow due to plaque build up which is mainly an accumulation of cholesterol and fat. The narrowing of arteries is known as atherosclerosis. Plaque Build up within the carotid artery causes a reduction in the blood supply to the brain. In severe cases, the plaque build up is so significant that it can result in a complete blockage of the carotid artery and cause a large stroke. Small plaque particles can also break-off (known as an embolus) the plaque and travel to the brain. If left untreated, both aspects of Carotid Artery Disease (or put carotid atherosclerosis) can cause a severe stroke. This occurs by either critically reducing of blood flow to the brain or by a small piece of detached plaque blocking one of the smaller arteries (called an embolism) in the brain or the eye.
Risk factors
Factors that increase the risk of carotid artery disease include:
- Age – more common in those >60yrs of age
- Gender – more common in males
- Diabetes
- High blood pressure
- High Cholesterol
- Smoking
- Family History
- Inactive lifestyle
- Obesity
Symptoms
Most people with carotid artery disease do not experience any symptoms until the artery is critically narrow and they experience a Stroke or a mini-stroke, also known as a Transient Ischemic Attack (TIA). Symptoms of a TIA or stroke can include:
- Sudden temporary loss of vision in one eye
- Sudden weakness or numbness in an arm or leg (on one side of body)
- Drooping of the face
- Difficulty speaking
- Sudden paralysis of one side of the body
If you think you are experiencing signs or symptoms of a TIA or stroke, seek help straight away, even if the symptoms are short-lived.
Symptoms
Most people with carotid artery disease do not experience any symptoms until the artery is critically narrow and they experience a Stroke or a mini-stroke, also known as a Transient Ischemic Attack (TIA). Symptoms of a TIA or stroke can include:
- Sudden temporary loss of vision in one eye
- Sudden weakness or numbness in an arm or leg (on one side of body)
- Drooping of the face
- Difficulty speaking
- Sudden paralysis of one side of the body
If you think you are experiencing signs or symptoms of a TIA or stroke, seek help straight away, even if the symptoms are short-lived.
Diagnosis
Diagnosis is usually made with a duplex ultrasound examination. Other imaging modalities such as a CT scan or MRI are alternative non-invasive ways of diagnosing carotid artery disease
- CT Angiogram. A CT scan involves injecting contrast (dye) into the veins while the head and neck are imaged using special X-rays taken from multiple angles and used to re-construct a 3D-image. The contrast results in the arteries to become more visible and the degree of narrowing in the arteries to be accurately defined. Unlike ultrasound, CT also allows the brain and the arteries within the skull to be examined.
- MRI. An MRI is similar to a CT scan in that it involves injecting contrast (dye) into the veins while the head and neck are imaged. Where CT uses radiation, the MRI uses magnetic imaging.
- Duplex Ultrasound. Ultrasound uses sound waves to interrogate the carotid artery, measure the flow within the vessel as well the degree of narrowing within it.
Ultrasound, MRI and CT offer different but complimentary information in diagnosing carotid artery disease. Your specialist will determine which one, or which combination, will be required.
Treatment
The most common treatment for severe carotid disease is carotid surgery, also known as endarterectomy. The surgery can be done under a local or general anaesthetic. It involves making an incision on the side of the neck, opening up the artery and removing the blockage from within the artery, thus improving the blood flow to the brain. Sometimes, a patch is used to repair the artery, ensuring it remains wider than before.
While the artery is being repaired, occasionally a tube (shunt) might be used to reroute the blood flow around the segment of artery being operated on.
In cases where surgery is deemed to be too high risk or technically difficult, the other option to open the artery is a carotid stent. This is most commonly performed under local anaesthetic, as an endovascular (keyhole) procedure.