Carotid Artery Disease

Carotid artery disease occurs when the arteries that carry blood from the heart to the brain become narrowed.

As with other vascular diseases, narrowing of the carotid arteries is most commonly caused by atherosclerosis, sometimes referred to as hardening of the arteries. Atherosclerosis is a gradual process in which cholesterol accumulates to form a plaque that clogs the blood vessels.

Carotid artery disease can cause a stroke if blood flow is cut off, leading brain cells to die and impairing body parts that those brain cells control. A stroke can cause lasting brain damage, paralysis or death.

Carotid artery disease develops slowly and often goes unnoticed before there are any symptoms. However, carotid artery disease can cause symptoms similar to a stroke, called transient ischemic attacks, or TIAs. TIA symptoms can last for a few minutes or as long as an hour and include:

  • Sudden weakness, numbness or tingling on one side of the face or body, or in a single limb
  • Difficulty speaking or slurred speech
  • Change in vision, such as losing all or partial vision in an eye
  • Imbalance
  • Confusion

If you experience a TIA, you may be at high risk for an impending stroke and should contact your physician immediately.

In most cases, carotid artery disease is caused by atherosclerosis. Risk factors include:

Less common causes of carotid artery disease are fibromuscular dysplasia, carotid artery dissection and carotid aneurysms.

Most often people are referred from a primary care doctor to a vascular specialist to determine if they have carotid artery disease. Your vascular specialist will try to determine if you have carotid artery disease and if so, the best treatment for you. Your consultation will include questions about your symptoms and your general health. The vascular surgeon will also conduct a physical exam, including listening for a bruit, an abnormal sound related to blood circulation which can signal narrowing of the artery.

If appropriate, your physician may order a carotid duplex ultrasound, a noninvasive ultrasound test to measure the degree of narrowing in the arteries of your neck. Other tests may be needed to complete a diagnosis, including magnetic resonance angiography (MRA), computerized tomographic angiography (CTA) or conventional angiography.

Significant improvements have been made in the diagnosis of carotid artery disease and other vascular diseases in the past few years, and Inova Schar Heart and Vascular has been at the forefront of those innovations.

Based on your symptoms and the severity of the blockage, your vascular specialist will recommend treatment. A less severe condition may be treated with lifestyle modifications, medication and monitoring. Surgery may be recommended for more severe cases. Both traditional open and minimally invasive options are available at Inova Schar Heart and Vascular.

Less Severe Cases

Carotid artery disease in which the narrowing of the carotid artery is mild or moderate and the patient is asymptomatic is most often treated with the following:

  • Lifestyle changes such as increased exercise, a healthy diet and smoking cessation
  • Treatment of existing conditions that may aggravate atherosclerosis, such as diabetes, high blood pressure and high cholesterol
  • Medications for maintaining blood flow, such as antiplatelet drugs, that reduce the ability of the blood to clot

More Severe Cases

In patients with significant narrowing of the carotid artery and symptoms, a more aggressive treatment may be recommended such as:

  • Carotid endarterectomy: This is the traditional, open surgery method of treating carotid artery disease. During the procedure, which is performed under local or general anesthesia, surgeons clamp the diseased carotid artery to stop blood from flowing through it, make an incision into the blocked section of the artery, and remove the plaque deposit. The surgeon may also widen the artery using a synthetic patch or the patient’s vein. Patients can usually go home the following day.
  • Carotid artery angioplasty with stenting (CAS): Our physicians have pioneered this minimally invasive procedure. A very small flexible tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder-like tube made of thin metal-mesh framework used to hold the artery open. An apparatus called an embolic protection device may be used while the stent is delivered into position. The device is a filter, like a small basket, that is attached on a guide wire to catch debris that may break off during the procedure.
  • Transcarotid Artery Revascularization (TCAR): TCAR is a minimally invasive, endovascular procedure that has demonstrated advantages compared to standard carotid stenting, especially for patients at higher risk of surgical complications, due to age, medical comorbidities or anatomical issues.

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