Vascular Surgery: Carotid Artery Disease
Stroke is the third most common cause of death in the United States, with a rate that is increasing as the population ages. The carotid and vertebral arteries are the blood vessels that carry blood to the brain. These arteries can develop a build-up of plaque with hardening of the arteries. With continued plaque buildup, severe narrowing of the carotid artery can occur, reducing blood flow to the brain. Portions of the plaque can also break off and travel to the brain (embolism). When either a severe narrowing or embolism occurs, a transient ischemic attack (TIA) or stroke may develop. A TIA is a temporary loss of brain function, causing symptoms which return to normal in a short time. A stroke causes permanent loss of brain matter, which may result in loss of normal body function.
People who are at risk for a stroke have atherosclerosis (hardening
of the artery), high blood pressure, smokers, high cholesterol,
diabetes, have had a prior stroke, have a family history of a stroke,
a history of bypass surgery, or an irregular heart beat.
Transient Ischemic Attacks (TIAs)
TIAs are also called mini-strokes. These
are temporary neurologic events which last from several seconds
to a few hours. The symptoms that occur, temporary blindness
or weakness in the arms or legs, can last no longer than 24 hours.
After that period of time it is considered a stroke.
This is a condition in which the patient may become
unsteady when standing, have visual changes or have weakness
or numbness and tingling on both sides of the body. This is primarily
due to reduced blood flow through the vertebral arteries and
is more likely to occur if there are also blockages in the carotid
This is when the neurologic deficits, such as weakness
or paralysis, are permanent. Here a part of the brain is damaged.
A few patients may benefit from surgery to clean out the carotid
arteries, but most patients are treated with medical therapy
and intense physical therapy and rehabilitation.
A carotid angiogram is a procedure performed by
a radiologist or a vascular surgeon. It is a test which maps
out the arteries that carry blood to the brainthe
carotid and the vertebral arteries. It helps to identify blockages
in these arteries and helps the vascular surgeon plan treatment.
An angiogram is an outpatient procedure that is done in the hospital.
A tiny catheter is passed through the groin (or arm) and a dye is
injected which fills the vessels in the neck and the brain, and
x-rays are taken.
Carotid Magnetic Resonance Angiogram (MRA)
MRA is a non-invasive test that is done in the
hospital. It is an outpatient procedure which takes images of
the blood vessels which carry blood to the brain (carotid and
vertebral arteries) without the use of x-rays. This test is similar
to an angiogram, but no catheters or guide wires are introduced
into the blood vessels; only an intravenous (IV) line is required.
A bruit is a sound that can be heard with a stethoscope
by your doctor. This sound is made by blood as it passes through
a narrowing in the carotid artery.
If a sound (bruit) is heard with a stethoscope
applied to the neck, or if you have symptoms of a stroke, a carotid
duplex is a quick, safe and reliable test to evaluate the carotid
and vertebral arteries.
Head CT Scan
This test gives us pictures of the brain and helps
us to determine whether you have had a stroke. It will show us
areas of bleeding or infarcted (dying) brain tissue. This will
allow your doctor to determine the appropriate treatment and
tests that you require.
Carotid endarterectomy is a surgery to reopen a
narrowed carotid artery. If you have symptoms of a stroke or
if the carotid narrowing is more than 60-70%, you may need surgery.
Information: Carotid Artery Surgery will help you prepare
for your surgical procedure. The average hospital stay is 1-2
Carotid angioplasty and stenting is a new treatment
modality which is currently offered to high risk patientsi.e.,
redo carotid surgery, high carotid blockages, multiple medical