• Carotid Artery Stenosis

    (Internal Carotid Artery Stenosis; Carotid Artery Disease)

    Definition

    Carotid artery stenosis occurs when the carotid arteries narrow. The carotid arteries are major arteries found on each side of the neck. They supply blood from the heart to the brain.
    This condition is a major risk factor for ischemic stroke . Ischemic stroke is when blood flow to the brain is blocked due to blood clots. Carotid artery stenosis is a potentially serious condition that requires care from your doctor.
    Blood Supply to the Brain
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    Causes

    Carotid artery stenosis is caused by the build-up of plaque along the lining of the arteries. This build-up is known as atherosclerosis . Plaque is made up of cholesterol, fat, and other substances.

    Risk Factors

    Risk factors include:

    Symptoms

    There are usually no symptoms. Tell your doctor if you have symptoms of a stroke or a transient ischemic attack (TIA or mini-stroke). This is a warning sign that you may have carotid artery stenosis. Symptoms may include:
    • Blindness, blurry or dim vision
    • Weakness, numbness, or tingling of the face, arm, leg, or one side of the body
    • Difficulty speaking or understanding words
    • Dizziness, unsteadiness of gait, or falling
    • Trouble with balance or coordination
    • Loss of consciousness
    • Nausea or vomiting
    • Sudden confusion or loss of memory

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will listen for irregular blood flow in the carotid arteries with a stethoscope.
    Tests may include:
    • Carotid ultrasonography—uses a device placed on the side of the neck to detect the narrow parts of the arteries
    • Computer tomography angiography (CTA)—uses computer enhanced x-ray images and a special liquid injected into the blood to examine blood flow through the arteries
    • Magnetic resonance angiography (MRA)—uses magnetic fields and a special liquid injected into the blood to make images of the arteries

    Treatment

    The goal of treatment is to prevent carotid artery stenosis from causing inadequate blood flow to the brain or causing a stroke. Treatment will depend on:
    • The severity of your condition
    • Your symptoms
    Talk with your doctor about the best treatment plan for you. Treatment options include:

    Medication and Lifestyle Changes

    If there are no symptoms and if plaque build-up is not severe, medicines like aspirin may be given to help prevent a stroke from occurring. Lifestyle changes are also an important part of treatment. Some actions you can take to reduce your risk of stroke include:
    • Eat a healthy diet .
    • Exercise regularly .
    • If you smoke , quit .
    • If you have diabetes, get proper treatment.
    • If you have high cholesterol, work with your doctor to lower the levels.
    • If you have high blood pressure, work to get it under control.

    Surgery

    Surgery may be needed if the arteries have severe plaque build-up. One kind of surgery is called carotid endarterectomy . This involves opening the artery and cleaning the plaque from it. Another surgery that may be done is carotid angioplasty and stenting. In this surgery, a balloon is inserted into the artery to widen it. Then a metal mesh, called a stent, is inserted to keep the artery open so that blood can flow freely.

    Prevention

    To help reduce your chance of getting carotid artery stenosis, you will need to decrease the risk factors that you can control. For example, you can reduce your cholesterol, blood pressure, and weight. Here are some steps to decrease these risk factors:
    • Exercise regularly.
    • Eat more fruits and vegetables . Limit dietary salt and fat .
    • Stop smoking.
    • If you drink alcohol, do so only in moderation . This means having no more than two drinks per day if you are a man, and no more than one drink per day if you are woman.
    • Maintain a healthy weight .
    • Keep your blood pressure in a safe range. Follow your doctor's recommendations if you have high blood pressure.
    • Keep other conditions under control. This includes high cholesterol and diabetes.

    RESOURCES

    American Heart Association http://www.americanheart.org/

    National Stroke Association http://www.stroke.org/

    CANADIAN RESOURCES

    Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/

    Prevent Stroke http://www.preventstroke.ca/

    References

    Buckley L, Schub T. Carotid stenosis. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Updated October 15, 2010. Accessed December 20, 2010.

    Carotid artery stenosis. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4497 . Accessed December 20, 2010.

    Carotid artery stenosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 6, 2010. Accessed December 20, 2010.

    Carotid artery disease. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/carotid-artery-disease/DS01030 Accessed December 20, 2010.

    Carotid artery disease: what is it? Vascular Disease Foundation website. Available at: http://www.vdf.org/diseaseinfo/carotid/ . Updated November 9, 2010. Accessed December 20, 2010.

    Lyons S. Peripheral vascular disease. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated October 18, 2010. Accessed December 20, 2010.

    Wood D. Stroke. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated November 11, 2010. Accessed December 20, 2010.

    Wood D. Transient ischemic attack. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 20, 2010. Accessed December 20, 2010.

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