CONDITIONS TREATED
Carotid Disease and Stroke
What is Carotid Disease?
Oxygenated blood is carried from the heart to your brain by the two carotid arteries,
one on each side of your neck. This blood supplies the part of your brain where
thought, speech, personality and your sensory and motor functions reside. Like other
vital blood vessels, the carotid arteries can develop fat and cholesterol deposits
- called plaque - on their walls which over time will narrow the artery and limit
normal blood flow to the brain. This can lead to a stroke if:
- this narrowing becomes extreme, or
- a piece of plaque breaks away and travels to a smaller and more easily blocked artery of the brain, or
- a clot may form and block a narrowed artery.
What symptoms may I have?
You may not experience any obvious symptoms of carotid artery disease until the warning signs of a transient ischemic attack (also called TIA or "mini-stroke"). If you experience a TIA you will have a temporary episode lasting a few minutes or a few hours, with symptoms including:
- blurring or no vision in one or both eyes;
- weakness and/or numbness in one side of your body, affecting your arm, leg or face;
- speaking becomes harder or slurred, swallowing may be difficult and you may not understand what others say;
- loss of coordination, with dizziness or confusion
As the progress of a TIA is impossible to predict, treat your symptoms as a medical emergency as fast treatment could be lifesaving or greatly increase your prospects of a full recovery.
Diagnosis
Abnormal blood flow (bruit) in the neck may be occasionally heard with a stethoscope, but duplex scanning is the most reliable and least invasive way to diagnose carotid artery disease. Diagnostic imaging tests include:
Duplex - uses high-frequency sound waves to view the blood vessels in the neck and highlight any narrowing in the carotid arteries. Recommended if you are over 60 or have heart disease.
Computerized Tomography (CT Scan) - this is most likely to be used following a TIA or larger stroke to see what possible damage to the brain may have occurred.
Angiography - using Digital Subtraction Angiography a computerised image of your arteries is built up following injection of a harmless contrast dye into your blood vessels. Rarely used now other than in circumstances to corroborate findings from other imaging modalities.
Treatment/Surgical Intervention
Like other arterial disease, that affecting your carotid arteries results from lifestyle choices and likewise is treatable through lifestyle changes, such as giving up smoking, reducing intake of saturated fats and cholesterol, control high blood pressure and diabetes and exercise more.
Blood thinning medications may also be prescribed to reduce blood clotting risk. These can range from a simple daily aspirin, to warfarin medications and most recently statins which target and reduce cholesterol to check or possibly reverse atherosclerosis. You should be checked regularly to ensure proper dosing for your condition.
Surgical intervention may be recommended, to restore adequate blood flow to the internal carotid artery, and prevent strokes. The two usual surgical options are:
- carotid endarterectomy - an operation during which your vascular surgeon removes the inner lining of your carotid artery if it has become thickened or damaged. This procedure eliminates a substance called plaque from your artery and can restore blood flow.
- Carotid artery stenting - this is a newer treatment with a growing body of evidence to support its use in some suitable patients. Your vascular surgeon together with a radiologist inserts a slender, metal-mesh tube, called a stent, which expands inside your carotid artery to increase blood flow in areas blocked by plaque.