CAROTID ARTERY DISEASE
Carotid artery disease is a disease characterized by the build-up of a fatty or waxy substance called plaque inside the carotid arteries.
- The carotid arteries are two large blood vessels located on each side of the neck right below the angle of the jaw line. They each divide into the internal and external carotid arteries
- The internal carotid artery supply oxygenated blood to the front part of the brain where thinking, personality, and sensory-motor functions exist.
- The external carotid artery supply oxygenated blood to the face, scalp, and neck.
- In carotid artery disease, these arteries become narrowed or blocked as a result of the buildup of plagues.
- This, in turn, may block the blood flow to the brain, leading to TIA (transient ischemic attack) – a temporary shortage of blood to the brain and increasing the risk of stroke.
- Carotid artery disease is a very serious condition.
CAUSES
Carotid artery disease is caused by atherosclerosis, a condition in which plaque builds up in the arteries.
These plaques are made up of clumps of cholesterol, calcium, fibrous tissues and other cellular waste that gathers at microscopic injury site in the lining of the artery wall.
Atherosclerosis can make the carotid arteries stiff and narrow, limiting the amount of oxygen and nutrient delivered to vital brain structures that help with our day to day activities.
A further narrowing of the artery over time may cause the plaque to rupture, causing blood clots to form. A large blood clot may completely block the artery or small clots and plaques may travel up to the smaller arteries in the brain causing disruption of blood supply to parts of the brain.
Certain factors that may increase the risk of carotid artery disease are:
- Smoking
- High blood pressure
- High cholesterol
- Age
- Obesity
- Sedentary lifestyle
- A family history of atherosclerosis
- Sleep apnea
- Diabetes
- Insulin resistance.
SYMPTOMS
- Confusion
- Problems with memory
- Sudden severe headache
- Difficulty speaking
- Difficulty swallowing
- Sudden dizziness or loss of balance
- Sudden difficulty seeing in one or both eyes, blurred vision, or vision loss
- Weakness or numbness or one side of the face, or in one arm or leg.
The condition does not often come up with symptoms in the early stage and may go unnoticed until the condition is serious enough to deprive the brain of blood.
DIAGNOSIS AND TREATMENT
To make a diagnosis, the doctor will review your medical history and carry out a physical exam.
During the physical exam, the doctor will listen to the arteries in your neck with the aid of a stethoscope. This is done to look for an abnormal sound, called bruit, which is characteristics of a narrowed artery.
After which the doctor may then recommend imaging tests such as:
- Ultrasound to assess blood flow and pressure in the carotid arteries
- CT or MRI to collect pictures of the brain to look for evidence of stroke or other abnormalities.
- CT angiography or MRI angiography to provide additional images of blood flow in the carotid arteries.
TREATMENT
The goal of treatment option is to prevent stroke and this may depend on the extent of the blockage in the carotid arteries.
A mild or moderate blockage may be treated with:
- Lifestyle changes which may include smoking cessation, weight loss, healthy eating, regular exercises, and salt intake reduction.
- Medications to control blood pressure or high cholesterol.
For severe blockage or if you have already had TIA or stroke, removing the blockage may be the best option. This may be done by:
Carotid endarterectomy where the affected carotid artery is opened, and the plaques removed or carotid angioplasty and stenting where a tiny balloon is inserted into the area of blockage and inflated to widen the artery so that a stent can be inserted to keep the artery from further narrowing.