Carotid Disease

(Stroke, stenosis)

The carotid arteries are two large vessels that run alongside of the neck that importantly supply blood to your brain. When these arteries become narrowed or blocked with plaque (carotid stenosis), blood flow to your brain is diminished. Outside of irregular heart rhythms, carotid stenosis is a leading cause of stroke.

Some signs and symptoms of a stroke to temporary stroke (TIA):

• Sudden loss of vision, blindness
• Sudden weakness, tingling, numbness on one side of the body
• Slurred speech or difficulty talking
• Facial droop
• Confusion

If you or someone you know are having signs and symptoms of a TIA or stroke, call 911 immediately. It is impossible to predict whether a TIA/stroke will worsen, so it must be treated as an emergency.

Risk factors for carotid disease include: smoking/nicotine use, hypertension (high blood pressure), high cholesterol levels, diabetes, family member with history of stroke, other diagnosis of coronary artery disease (heart vessel disease/CAD) or peripheral vascular/arterial disease (PVD/PAD), and increasing age >60 years.

Testing includes: Carotid ultrasound, CT angio scan, or cerebral angiogram.

If significant disease is left untreated, small pieces of the plaque or a blood clot can break off and flow into the brain to cause stroke/TIA.

Treatment:

Open surgical management of carotid stenosis is called a carotid endarterectomy and has been performed by Vascular Surgeons for many decades. It involves an incision made along the side of the neck to carefully remove the plaque build-up within the carotid artery. A patch is then used to close the opening made in the artery to ensure the vessel does not get narrowed by the surgery. Most patients stay overnight in the hospital and are able to discharge home the next day.

TransCarotid Artery Revascularization (TCAR) is an innovative, minimally invasive manner of placing a stent the carotid artery to support the vessel from the inside. A small incision is made at the base of the neck and after accessing the carotid artery using catheter-based techniques, a specialized system to prevent debris travelling to the brain during the procedure is used, so that manipulation of the plaque (which could otherwise cause stroke) can be safer during stent placement compared to other carotid stenting techniques. Please ask your Vascular Surgeon why TCAR can be a safer approach than transfemoral stenting (stenting from the leg vessel).

Carotid procedures can be performed to prevent stroke in addition to treating strokes that have already occurred due to carotid stenosis. If you have any of the risk factors listed, speak to your primary doctor about being screened for carotid disease or for a Vascular Surgeon referral.