Carotid Artery Disease Treatment

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Carotid artery disease is when the arteries become narrowed or blocked by a buildup of plaque (atherosclerosis). Too much plague, which is typically made up of fat, cholesterol calcium, and other substances, can cause a blockage. This condition is very serious as it can block blood flow to the brain, causing a stroke.

Exams for diagnosis

Doctor’s exam: On examination, the doctor, using a stethoscope, may hear a bruit (swishing sound synchronous with the heart pulse) over the carotid artery. The bruit usually means that there is a significant stenosis (or abnormal narrowing) of the carotid artery.

Doppler/Duplex Ultrasound: A sensor connected to a special computer and monitor is placed over the carotid artery in the neck and images the flow of blood in the artery. The presence and approximate degree of stenosis can be determined.

Angiography: A catheter introduced into the femoral artery in the groin is passed upwards through the aorta and then under fluoroscopic control into each common carotid artery. A dye that shows up on X-ray is injected through the catheter. Serial X-ray films or angiograms are then obtained from the carotid artery circulation. Review of the films demonstrates whether stenosis is present and the degree of the stenosis.  

Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI): Both these exams produce images of the brain which may demonstrate evidence of present or past strokes or evidence of a blood clot.

CT or MRI Angiography: These are special types of CT and MRI that produce angiograms without the passing a catheter. These tests are more accurate than Duplex Ultrasound but not as accurate as the standard angiograms.

Treatment: Carotid endarterectomy and carotid stenting

Carotid endarterectomy is a procedure that treats carotid artery disease, which occurs when fatty, waxy deposits (or plaque) build up in the carotid arteries (blood vessels located on each side of the neck).

When the plaque builds up, it can restrict blood flow to the brain. Carotid endarterectomy removes the plaque that is causing narrowing in the artery, which then improves blood flow and drastically reduces the risk of stroke.

Carotid stenting involves placing a stent (or small metal coil) in the clogged artery, which props open the artery and decreases the chance of it narrowing again. This method may be used when carotid endarterectomy is too risky or is not possible with the patient.

After the procedures

A change in lifestyle reduces the risk of further problems in the arteries:

  • Stop smoking
  • Begin a low-fat diet
  • Check blood cholesterol at least twice per year
  • Control diabetes and high blood pressure
  • Have a regular exercise program
  • Follow up with the doctor at regular intervals

 

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