Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid (kuh-ROT-id) arteries (one on each side of the neck) that carry blood to the brain. You can feel your carotid arteries on each side of the lower part of your neck, right below the angle of the jaw.
The carotid arteries send blood to the large, front part of the brain. This is the section that controls thinking, speech, personality and sensory and motor functions.
The vertebral (ver TEE brul) arteries run through the spine. They send blood to the back part of the brain (the brainstem and cerebellum [sara BELL um]).
Carotid artery disease means the carotid arteries have become narrowed. The condition is called carotid artery stenosis (sten-OHsis). Carotid artery disease is usually caused by atherosclerosis (ath-er-oh- skler-OH-sis). Atherosclerosis is sometimes called “hardening of the arteries.” It is caused by a buildup of cholesterol, fat and other substances that travel through the bloodstream, such as inflammatory cells, cellular waste products, proteins and calcium. Over time, these substances stick to the blood vessel walls and combine to form a material called plaque (PLACK).
Plaque buildup can cause the carotid arteries to become narrow or blocked, which reduces blood flow to the brain.
A stroke happens when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it depends on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing surrounding nerve cells to be cut off from their supply of nutrients and oxygen. When tissue is cut off from its supply of oxygen for more than 3 to 4 minutes, it begins to die.
You can have a stroke if:
A stroke also can also be caused by other conditions, such as sudden bleeding in the brain (intracerebral hemorrhage), sudden bleeding in the spinal fluid space (subarachnoid hemorrhage), atrial fibrillation, cardiomyopathy or blockage of the tiny arteries inside the brain.
Risk factors for atherosclerosis, which can lead to carotid artery disease, include:
Typically, carotid artery disease happens a few years later than coronary artery disease. Coronary arteries supply blood to the heart. People who have the coronary artery disease have a higher risk of developing carotid artery disease.
There are no symptoms of carotid artery disease itself. But you may have warning signs of a stroke. A transient ischemic attack (TIA or “mini-stroke”) is one of the most important warning signs. A TIA happens when a blood clot briefly blocks blood flow to the brain. Symptoms of a TIA and a stroke are the same, but they last only a short time (minutes to fewer than 24 hours) during a TIA. Symptoms include one or more of the following:
A TIA is a medical emergency because it is impossible to know if it will turn into a major stroke. If you or someone you know has symptoms of a stroke/TIA, call 999. Getting treatment right away can save your life and increase your chance of a full recovery.
A person who has had a TIA is 10 times more likely to have a major stroke than someone who has not had a TIA.
If you are at risk of carotid artery disease, it is very important to have regular physical exams.
A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (BROO-ee), can mean you have carotid artery disease. But, you may have a blocked artery and not have bruits. You may also have a bruit even if the blockage is minor.
Diagnostic tests include:
If you have carotid artery disease, your treatment may include:
To prevent carotid artery disease from getting worse, these lifestyle changes are recommended by your doctor and the National Stroke Association:
If you have severe narrowing or blockage in the carotid artery, you will need a procedure to open the artery. This increases blood flow to the brain and prevents a future stroke. These procedures include carotid endarterectomy and carotid stenting.
Carotid endarterectomy is the traditional surgical treatment for patients with carotid artery disease. It is an effective treatment for many patients, especially those who have symptoms and at least a 50% blockage of the carotid arteries and those without symptoms who have at least a 60% blockage.
Carotid endarterectomy can be performed using general or local anesthesia. Your surgeon will make an incision in your neck where the artery is blocked. The plaque is removed from the artery, then the incision is closed and normal blood flow returns to the brain.
Carotid angioplasty and stenting is a possible treatment for some patients. You can ask your doctor if the treatment is an option for you.
Carotid angioplasty and stenting is performed while you are awake but sedated. A balloon catheter is put inside a blood vessel. The doctor uses an x-ray to guide the catheter to the blocked or narrowed area of the carotid artery. A special guidewire with a filter (embolic protection device) is placed past the area of blockage or narrowing.
Once in place, the balloon tip is inflated for a few seconds to open or widen the artery. The filter collects any debris that may break off of the blockage. A stent (a small mesh tube) is placed in the artery and opens to fit the size of the artery. The stent stays in place permanently and acts as a scaffold to support the artery walls and keep the artery open. After several weeks, the artery heals around the stent.
Research shows that carotid stenting plus the filter is as safe and works as well as carotid endarterectomy for patients who are considered high risk for surgery.
Recovery from both the carotid endarterectomy and carotid angioplasty and stenting procedures generally requires a one-night hospital stay. Patients often return to regular activities within one to two weeks after these procedures.
Your doctor will let you know how often you need to be seen and which tests you will need to keep track of how you are doing and how well your treatment is working.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
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