Carotid Artery Disease (cont.)
How Is Carotid Artery Disease Diagnosed?
Carotid artery disease may not have symptoms. It is important for those at risk to have regular physical exams by their doctor. A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (BROO-ee) may indicate you have disease. Bruits are not always present when blockages are present and may be heard at times even with minor blockages. It is important to let your doctor know if you have had any symptoms, such as those listed above.
Diagnostic tests include:
- Carotid duplex ultrasound. An imaging procedure that uses high-frequency sound waves to view the blood vessels in the neck and to determine the presence of narrowing in the carotid arteries. This study is recommended in anyone with heart disease and anyone over the age of 60.
- Carotid angiography (carotid angiogram, carotid arteriogram, carotid angio). If carotid artery disease is suspected, prior to treatment, your doctor may schedule an arteriogram. This is an invasive imaging procedure that involves inserting a catheter into a blood vessel in the arm or leg, and guiding it to the carotid arteries with the aid of a special x-ray machine. Contrast dye is injected through the catheter so that x-ray movies of your carotid arteries are taken.
- Computerized tomography (CT Scan). A CT of the brain may be performed if there is a possibility a stroke has already occurred. This test will reveal areas of damage on the brain.
How Is Carotid Artery Disease Treated?
Carotid artery disease is treated by:
- Lifestyle modification
- Medications
- Procedures
Lifestyle Modification
To prevent further progression of disease, lifestyle modification is recommended to limit all risk factors for coronary and carotid artery disease. These modifications include:
- Quit smoking and using tobacco products
- Control high blood pressure and diabetes
- Have regular check-ups with your doctor
- Have your doctor check your lipid profile and get treatment, if necessary to reach a lipid goal of LDL less than 100 and HDL greater than 45
- Eat foods low in saturated fats and cholesterol
- Achieve and maintain a desirable weight
- Exercise regularly
- Control other stroke risk factors: limit the amount of alcohol you drink and if you have atrial fibrillation, you should be on blood-thinning medications
Medications
All people with carotid disease should be on aspirin to decrease the risk of stroke due to blood clots. In some cases, Coumadin (warfarin) may be prescribed. If so, blood work will need to be checked regularly to ensure you are on the proper dose.
Procedures
If the carotid artery has severe narrowing or blockage, a procedure must be done to open the artery and allow blood flow to the brain, to prevent future stroke:
- Carotid stenting. This interventional procedure is currently under investigation. Performed in a catheterization laboratory, a small puncture is made in the groin. A specially designed catheter, with an umbrella tip is placed over a guide wire and directed to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to dilate the artery. Then, a stent (a small stainless steel mesh tube that acts as a scaffold to provide support inside your artery) is placed in the artery and opens to fit the size of the artery. Tiny filters are used to capture any particles that are released and prevent them from going to the brain and causing a stroke. The stent stays in place permanently. After several weeks, your artery heals around the stent Research is underway to study the effectiveness and safety of carotid stenting. It is hoped this procedure will offer a non-surgical option to treat carotid artery disease.
- Carotid endarterectomy. This is the standard surgical treatment for carotid artery disease. While the patient is under general anesthesia, an incision is made in the neck, at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow blood flow to the brain.
Reviewed by the doctors at The Cleveland Clinic Heart Center.
Edited by Charlotte E. Grayson, MD, June 2004, WebMD.
Portions of this page © The Cleveland Clinic 2000-2004
Last Editorial Review: 1/31/2005 10:42:01 AM
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