Carotid Artery Disease
What is CAD?
Two main blood vessels carry oxygen and blood to the brain which are located on either side of your neck. These are called the carotid arteries. When these arteries become narrowed or blocked, it’s known as carotid arterial disease. Sometimes it may be called carotid artery stenosis.
What causes CAD?
The most common cause of CAD is atherosclerosis. This is when cholesterol, fat, and other products in the bloodstream such as proteins and calcium build up on the artery walls forming a substance called plaque. Plaque buildup can cause the arteries to become narrow, either restricting or blocking blood flow.
Symptoms
There may be no symptoms of having carotid arterial disease. Sometimes the first sign that something is wrong is a transient ischemic attack (TIA) or ‘mini-stroke’. This is where a blood clot may briefly interrupt the supply of blood to the brain. Symptoms of a TIA are usually temporary but they can last anywhere from a few minutes to a few hours. It’s possible to experience one, or several symptoms as a result of a TIA. Typical symptoms include:
· sudden loss of vision or blurred vision in one or both eyes
· sudden numbness or weakness in the face or limbs, usually on one side of the body
· drooping on one side of the face
· sudden, severe headache
· dizziness, loss of balance or confusion
· sudden loss of coordination
· slurred or garbled speech or difficulty talking
· difficulty understanding what others are saying
· difficulty swallowing.
A TIA is a medical emergency as it may progress to a major stroke. You should seek urgent medical attention if any of the above symptoms are noticed.
Someone who has had a TIA is 10 times more likely to experience a major stroke than someone who has not.
Risk factors
There are a number of factors that increase your risk of developing CAD. These include:
· high blood pressure
· high cholesterol
· smoking
· diabetes
· age (incidence increases with age)
· family history
· being overweight
· sedentary lifestyle
Complications of PAD
CAD is a serious medical problem as blocked arteries can interrupt the blood supply to your brain which may lead to a stroke. This is where a lack of blood and oxygen supply to the brain causes brain tissue to become damaged or die. A stroke can result in brain damage, long-term disability or death. CAD-related strokes can occur as a result of:
· reduced blood flow to the brain
· pieces of plaque breaking off and flowing to smaller arteries, creating a blockage of blood flow
· blood clots that slow or block blood flow to the brain.
Diagnosis
CAD is usually diagnosed by taking a detailed medical and family history, and via a physical examination where the doctor will listen to the arteries in your neck with a stethoscope. Swooshing sounds made by abnormal blood flow called bruit (pronounced BROO-ee) can indicate CAD. Other tests that may be required include:
· Carotid duplex ultrasound — This imaging procedure is the most commonly used for diagnosing CAD and is used to check for signs of narrowing of the arteries.
· Carotid angiogram — For this test, a contrast dye is injected into your blood vessels which shows up on an x-ray. This may be used to determine narrowing or blockage in the carotid arteries or determine the risk of future stroke.
· Imaging tests — A CT (computerised tomography) scan or MRI (magnetic resonance imaging) test may be used to check for narrowed sections of blood vessels or evidence of a stroke.
Treatment
Treatment of CAD aims to prevent stroke. Treatment required will depend on the extent of the blockage, and your risk for stroke. It may involve several things including non-surgical and surgical treatments.
Non-surgical treatments
· Lifestyle modifications can control risk factors for stroke and involve quitting smoking, losing weight, regular exercise, and healthy eating.
· Medications to:
o control blood pressure
o lower cholesterol
o prevent blood clots
Surgical treatments
· Carotid endarterectomy — This is the most common form of surgery for severe carotid artery disease and is performed under local or general anaesthesia. During this procedure, the surgeon makes an incision on the front of the neck, opens the carotid artery and removes any blockages. The artery is then stitched closed. This procedure is very effective in preventing strokes.
· Carotid angioplasty and stenting — This procedure is usually performed if the blockage is too difficult to reach via an endarterectomy, or if other health conditions could make surgery risky. This procedure involves threading a thin tube (catheter) into the narrowed blood vessel. When the catheter reaches the blockage in the blood vessel, a small balloon inflates from the tip which widens the blood vessel and improves the blood flow. A tiny mesh tube (stent) is then inserted into the artery to prevent it from narrowing again.
When to seek medical advice
CAD is a serious medical condition so it’s important that if you’re diagnosed with it, you should continue to have regular check-ups with your health professional
You and your family should also learn the symptoms of stroke and call for an ambulance immediately on 000 if you suspect a stroke is occurring or has occurred
References:
Australia and New Zealand Society for Vascular Surgeons, Asymptomatic Carotid Disease, https://www.anzsvs.org.au/patient-information/asymptomatic-carotid-disease/
Cleveland Clinic, Carotid Artery Disease (Carotid Artery Stenosis) https://my.clevelandclinic.org/health/diseases/16845-carotid-artery-disease-carotid-artery-stenosis
Healthline, Carotid Artery Disease: Symptoms, Tests, Prevention, and Treatment, https://www.healthline.com/health/carotid-artery-disease
Healthline, Everything You Need to Know About Stroke https://www.healthline.com/health/stroke
John Hopkins Medicine, Carotid Artery Disease https://www.hopkinsmedicine.org/health/conditions-and-diseases/carotid-artery-disease
Mayo Clinic, Carotid artery disease, https://www.mayoclinic.org/diseases-conditions/carotid-artery-disease/symptoms-causes/syc-20360519
National Heart, Lung, and Blood Institute, Carotid Artery Disease,https://www.nhlbi.nih.gov/health-topics/carotid-artery-disease