Carotid Artery Disease

Carotid artery disease is a vascular (circulatory system) disease affecting the carotid arteries, the main blood supply for the head and brain. The arteries can become narrowed or blocked, reducing or cutting off blood flow to the brain. This condition is also called carotid stenosis.

Carotid arteries can become diseased when cholesterol and other fatty substances collect inside their walls, forming a buildup called plaque. This process, known as atherosclerosis, gradually reduces blood flow to the brain.

Since two arteries supply the brain with blood, a problem with one may not pose an immediate danger. Still, a narrowed or blocked artery requires urgent attention.

Blood supply can also become blocked in parts of the brain if:

• Plaque breaks off and gets stuck
• Atherosclerosis causes a blood clot to form

Risk factors for carotid artery disease

Risk factors for carotid artery disease include some you can control and some you often can’t.

Risk factors you can control:

• Lack of exercise
• Smoking
• Unhealthy diet

Risk factors you may not be able to control:

• Diabetes
• Excess weight or obesity
• Family history of stroke, atherosclerosis or coronary artery disease
• High blood pressure
• High cholesterol
• Older age

Carotid artery disease develops gradually over many years, so you may not notice symptoms in the early stages. The first signs or symptoms may be those of a stroke or ministroke (transient ischemic attack, or TIA):

• A TIA happens when a blood clot briefly blocks a carotid artery. The symptoms last from a few minutes to 24 hours, and a TIA does not cause permanent damage or disability.
• A stroke occurs when a blood clot blocks a carotid artery for a longer period. A stroke can cause lasting damage because brain cells begin to die within minutes due to the lack of oxygen.

A TIA is considered an early warning sign of a future stroke. About 40 percent of people who have a TIA go on to have a stroke. Almost half of all strokes happen within a few days after a TIA.

Symptoms of stroke and ministroke

Because the immediate signs and symptoms of TIA and stroke are identical, it’s impossible to know which condition you’re experiencing. Seek medical attention right away if you have any of these signs or symptoms:

• Blurred vision or vision loss in one or both eyes
• Confusion or memory loss
• Difficulty speaking and understanding others
• Dizziness
• Loss of coordination and balance
• Numbness or weakness on one side of your face and/or body

At Henry Ford, our vascular surgeons conduct a thorough evaluation to determine the cause of your symptoms. An accurate diagnosis helps us recommend the appropriate treatment options for your needs.

Your first visit usually includes:

• Questions about your symptoms, medical history and possible risk factors
• Review of your family health history
• Physical exam, including listening to your carotid arteries with a stethoscope for a whooshing sound (carotid bruit), a sign of a narrowed artery
• Tests of memory, speech and strength during a neurological exam, given for certain symptoms

Imaging and other tests for carotid artery disease

Our experienced imaging technologists use the latest equipment in our nationally accredited vascular testing labs, for precise results. Testing you may need includes:

• Angiography/arteriography: We make a small incision to access an artery, then insert a catheter (thin, flexible tube) and guide it to the affected area. After injecting a substance called a contrast agent that highlights arteries, we take X-rays.
• Blood tests: We take a sample of your blood to check for high cholesterol and high blood sugar, a sign of diabetes.
• Computed tomography angiography (CTA): This angiography procedure uses CT, a type of specialized X-ray equipment, to produce images of the carotid arteries. CTA is minimally invasive because the contrast agent is injectable.
• Doppler ultrasound: Sound waves measure movement inside the body, such as blood flow through arteries.
• Duplex ultrasound: Traditional ultrasound (still images) combined with Doppler ultrasound examines blood flow in the neck for signs of narrowing or blockage.
• Magnetic resonance angiography (MRA): An angiography uses imaging from a large magnet and radio waves to look at blockages in the carotid arteries. MRA avoids the need to go inside the blood vessel because the contrast agent is injectable.

Our specialists offer every available treatment for carotid stenosis, working to prevent stroke and slow or stop atherosclerosis. Your care team works closely with you to customize a treatment plan to your specific needs. Your options depend on your symptoms, severity of disease, age and overall health.

If you have more severe narrowing or blockage, you may need advanced treatment. Our board-certified vascular surgeons have extensive training and experience in both minimally invasive procedures and open surgery.

It’s important to choose a surgeon with intimate knowledge of both minimally invasive and open procedures and when to use each. We help you decide which type can offer you the best possible results.

Treatment with medications and lifestyle changes

If you have mild to moderate disease, we typically begin your treatment with lifestyle changes and medications to manage risk factors. Our vascular medicine specialists offer treatment options that include:

Recommendations for healthy lifestyle habits

Small lifestyle changes can slow atherosclerosis and improve the way you feel. Our vascular medicine specialists have years of experience helping people develop realistic goals to:

• Quit smoking
• Eat a more nutritious diet that’s low in cholesterol, saturated fats and sodium
• Stay physically active
• Maintain a healthy weight
• Drink less alcohol — typically one drink or less per day for women and two or less for men

You can work with us one-on-one, or we can refer you to Henry Ford programs such as:

• Tobacco Treatment Service, which includes options for individual coaching by phone and Freedom From Smoking® classes
• Henry Ford PREVENT Program, a medically supervised exercise program with individual and group options, nutrition classes and education on healthy habits

Medications for carotid artery disease

Depending on your specific symptoms and other health needs, our vascular medicine specialists prescribe medications such as:

• Blood thinners to prevent blood clots and reduce the risk of stroke
• Insulin or other drugs to manage blood sugar
• Medications to lower blood pressure
• Statins to control high cholesterol

Angioplasty and minimally invasive treatments for carotid artery disease

Endovascular procedures go inside the artery to provide treatment and require just a small incision. Most people can go home within a couple of days. You heal faster after a minimally invasive procedure, for an easier recovery.

Endovascular procedures from our vascular surgeons include angioplasty and stenting. We often do these procedures at the same time as a diagnostic angiogram. Your doctor takes pictures, then guides a catheter tipped with a tiny balloon to the blocked area. The doctor inflates the balloon to press any blockages against the artery’s walls, widening it to improve blood flow. We sometimes insert a stent (tiny mesh tube) to keep the artery open. Some stents have slow-release medications that help prevent future blockages.

Hybrid procedure for carotid artery disease

Transcarotid artery revascularization (TCAR) combines an open and an endovascular approach to treat narrowed or blocked arteries. This hybrid approach minimizes the risk of stroke during and after the procedure. Find out more about TCAR.

Endarterectomy (surgery) to treat carotid artery disease

People whose carotid arteries are more than 50 percent blocked may need an open surgery called carotid endarterectomy. Our expert vascular surgeons safely remove the blockage and reduce the risk of stroke.

To start, your surgeon makes an incision to open the carotid artery at the blocked area. The surgeon then removes the plaque and, in some cases, the diseased part of the artery. If needed, the surgeon closes the artery with a patch made of synthetic material or a portion of another blood vessel.