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Carotid Artery Disease (Carotid Stenosis)

Related Services
 
 
Screening and Prevention
 
At UW Health in Madison, Wisconsin, our Heart and Vascular Care team provides expert treatment for carotid artery disease.
 
What is carotid artery disease?
 
Carotid stenosis is a hardening of the neck arteries. This occurs when a build-up of plaque causes narrowing or blockage of the artery. This build-up may be silent, but if a piece of plaque breaks off and travels to an artery in the brain, it can cause a blockage or even a stroke.
 
Stroke caused by carotid stenosis is most common in older people. Often times patients have atherosclerotic heart disease or diabetes. Radiation therapy may also cause carotid stenosis.
 
Symptoms
 
Many patients with carotid stenosis have no symptoms, and the condition is diagnosed during a physical exam. Other patients may have symptoms that are either transient (TIA, or transient ischemic attack) or permanent:
  • Weakness or total inability to move a body part
  • Numbness, loss of sensation
  • Tingling or other abnormal sensations
  • Decreased or lost vision (may be partial or temporary)
  • Language difficulties (aphasia)
  • Inability to recognize or identify sensory stimuli (agnosia)
  • Loss of memory or coordination
  • Swallowing difficulties
  • Personality changes or mood and emotion changes
  • Urinary incontinence (lack of control over bladder)
  • Lack of control over the bowels
  • Consciousness changes including sleepiness, stupor, lethargy, coma or unconsciousness

Exams and Tests

 

The following tests may be performed:

  • Serum lipids blood test (may show high levels of triglycerides and cholesterol)
  • Carotid or cerebral angiography
  • Carotid duplex or Doppler ultrasound
  • Magnetic resonance imaging (MRI) of the head
  • Magnetic resonance angiography (MRA)  of the brain vessels and neck vessels

An exam may reveal blood clots in the retina, reflex problems, muscle weakness, decreased sensation and/or a bruit (an abnormal sound heard with the stethoscope) over the carotid arteries of the neck.

 

Treatment

 

Restoring the normal flow channel in the carotid artery can diminish the risk of stroke. This may be accomplished either by an operation called carotid endarterectomy or a procedure known as angioplasty with stent placement.

 

Carotid endarterectomy removes the plaque and the inner layers of the artery. Stent placement is an alternative to surgery that enlarges the blockage in the artery. Patients should be evaluated by physicians knowledgeable in the benefits and risks of both procedures.

 

Surgery should also be done for those who have carotid artery blockages which cut off between 75-99 percent of blood flow. Large studies have shown the risk of stroke is reduced with surgery for people with such severe blockages.

 

If the blockage is complete (100 percent), however, surgery will not be performed because the risk of stroke and significant brain damage from the procedure is too great.

 

Prognosis

 

Carotid artery surgery usually helps prevent further brain damage and reduces the risk of stroke. However, unless lifestyle changes (like diet and exercise when approved by your physician) are made, plaque build-up, clot formation and other problems in the carotid arteries can return.

 

Recovery

 

After surgery, you are usually observed overnight to watch for any signs of bleeding, stroke or compromised blood flow to the brain. Erratic blood pressure (requiring monitoring in an intensive care unit) is relatively common, tends to improve within 24 hours and should not be a cause for concern.