Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Carotid Atherosclerotic

Appointments

Carotid Atherosclerotic Disease

The neurosurgeons at Houston Methodist Hospital Neurological Institute Cerebrovascular Center diagnose and treat many kinds of cerebrovascular conditions, including carotid atherosclerotic disease.

Overview

The carotid arteries in your neck deliver blood to the brain. Over time, plaque (cholesterol, fatty deposits and other materials) can build up in the carotid arteries, causing them to narrow and harden. This is called carotid atherosclerotic disease, carotid atherosclerotic stenosis, carotid artery disease, or “hardening of the arteries.” If the narrowing is severe enough to restrict blood flow to the brain, it can cause a stroke.

If a diseased carotid artery cracks or ruptures (bursts), this can cause blood to leak and form a clot, which can block blood flow and cause a stroke. Sometimes plaque can also break loose, block an artery in the brain, and cause a stroke.

Atherosclerosis is the most common cause of artery disease. It usually progresses slowly. Risk factors for carotid atherosclerosis disease include:

  • Age
  • Smoking
  • Diabetes
  • Obesity
  • High-fat diet
  • Lack of exercise
  • Alcohol or drug abuse
  • Family history and genetic factors
  • High blood pressure (hypertension)
  • Elevated fats in the blood (hyperlipidemia)

Symptoms

Carotid artery disease usually doesn’t cause any symptoms until the arteries are narrow enough to reduce the blood flow to the brain. However, sometimes even narrow arteries don’t cause symptoms. Because this disease often progresses without symptoms, the first signs may be serious, such as a transient ischemic attack (TIA or mini stroke) or stroke. TIA and stroke symptoms may include:

  • Confusion
  • Headache
  • Dizziness or fainting
  • Unclear or slurred speech
  • Temporary blurred vision or vision loss
  • Clumsiness or losing coordination
  • Numbness in the face, arm, or leg
  • Sudden weakness on one side of the body
  • Suddenly being unable to move (paralysis) an arm, leg, or one side of the body

Diagnosis

In addition to a physical exam, several tests can help determine whether you have carotid atherosclerosis disease.

  • Duplex or Doppler ultrasound uses sound waves to show your blood vessels and measure how fast your blood flows. It can help determine where there is narrowing or blockage in your artery, and how severe it is.
  • Computerized tomography angiogram (CTA) uses a contrast (dye) to highlight your carotid arteries. First a dye is injected into a blood vessel, which travels your carotid arteries. Then CT images are taken of your head and neck to look for possible narrowing or blockages.
  • Computerized tomography (CT) scans that don’t use contrast may also be taken of your head to look at brain tissue. This is often used to rule out bleeding or other problems.
  • Magnetic resonance angiography (MRA) combines contrast with magnetic and radio waves to create cross-sectional and three-dimensional images of arteries in your neck and brain.
  • Magnetic resonance imaging (MRI) creates images of your brain tissue without using contrast. This is often used to look for signs of an early stroke or other problems.
  • Cerebral angiogram is a procedure where the surgeon inserts a thin catheter through the groin and threads it into your carotid arteries. Contrast is then injected through the catheter to help the arteries show up on detailed X-rays.

If you are diagnosed with carotid atherosclerotic disease, our team of specialists will work with you to develop a personalized treatment plan based on the degree of your stenosis, your symptoms, and your overall health.

Treatment Options

Houston Methodist offers both carotid endarterectomy, and angioplasty and stenting to treat carotid atherosclerosis.

Carotid Endarterectomy (CEA)

A carotid endarterectomy (CEA) procedure can restore blood flow and lower the risk of having a stroke. During this surgery, a neurosurgeon makes a small incision in your neck and removes the inner lining of your carotid artery that contains the plaque. Sometimes the doctor makes a patch to widen the artery. This can be done using part of another vein or a synthetic material.
CEA may or may not be right for you depending on:

  • How severe your narrowing is
  • What kinds of symptoms you are experiencing
  • Whether you have had a stroke
  • Your overall health status

Carotid Angioplasty and Stenting

Carotid stenting often begins with a balloon angioplasty, where a surgeon inserts a balloon-tipped catheter into your artery to widen it and flatten the plaque. Then a stent (mesh tube) is placed to keep the artery open and allow more blood to flow through. This minimally invasive procedure is a better treatment option for some people, especially if they are not good candidates for carotid endarterectomy.

Recovery and Rehabilitation

After a carotid endarterectomy or stenting procedure, you will be taken to a recovery room until you wake up and your vital signs (blood pressure, breathing rate) are stable. Then you will be taken to a regular hospital room or intensive care unit (ICU) room to further recover. Most patients are able to leave the hospital within a day or two.

When you return home, make sure to follow your surgeon’s advice about returning to your normal activities, taking care of the insertion site, and watching out for any warning signs such as fever, chills, unusual pain, or bleeding or swelling at the insertion site. You may need to have periodic exams or ultrasounds so your doctors can monitor your condition.

Additional Resources

PubMed Health
American Stroke Association
National Heart, Lung, and Blood Institute
Society for Vascular Surgery (VascularWeb)