Carotid Atherosclerotic Disease

The neurosurgeons at Houston Methodist diagnose and treat many kinds of cerebrovascular conditions, including carotid atherosclerotic disease.

Carotid atherosclerotic disease occurs when plaque (cholesterol, fatty deposits and other materials) builds up in the carotid arteries — the arteries in your neck that deliver blood to the brain — causing them to narrow and harden. This condition is also referred to as carotid atherosclerotic stenosis, carotid artery disease or “hardening of the arteries.” If the narrowing of the artery is severe enough to restrict blood flow to the brain, it can cause a stroke. Strokes may be caused either by clots or by bleeding (hemorrhage) that deprives brain cells of oxygen, leading to their death. Pieces of plaque can also break loose, block an artery in the brain and cause a stroke.

Atherosclerosis is the most common cause of artery disease and usually progresses at a slow pace. Multiple  risk factors for carotid atherosclerosis disease have been identified:

• 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)
• Excessive alcohol consumption 

Symptoms of Carotid Atherosclerotic Disease
Patients with carotid artery disease often do not exhibit any symptoms until the arteries have narrowed enough to reduce the blood flow to the brain. Even then, no symptoms may be present. The first symptoms may occur during a temporary blockage of blood flow to the brain (transient ischemic attack, TIA, or mini stroke) or stroke and may include the following:

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

Diagnosis of Carotid Atherosclerotic Disease
In addition to a physical exam, several tests can help determine whether you have carotid atherosclerosis disease and/or early signs of stroke. These techniques are used to assess or visualize your blood vessels and other tissues.

• 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 to 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 do not use contrast dyes 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 dye with magnetic fields 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 dye. MRI uses magnetic fields and radio waves to create images. MRI 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 (flexible tube) through the groin and threads it into your carotid arteries. Contrast dye 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 carotid artery stenosis (or narrowing), your symptoms and your overall health.

Treatment Options for Carotid Atherosclerotic Disease
Houston Methodist offers carotid endarterectomy, angioplasty and stenting to treat carotid atherosclerosis.

Carotid endarterectomy (CEA)
A carotid endarterectomy 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, which can be done using part of another vein or a synthetic material.

Your doctor will consider several factors to determine whether CEA is the right treatment for you:

• The severity of your carotid artery narrowing 
• The 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, in which a surgeon inserts a balloon-tipped catheter into your artery to widen it and flatten the plaque. Then a stent (mesh tube) is placed (inserted) to keep the artery open and allow more blood to flow through it. 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 From Treatment for Carotid Atherosclerotic Disease
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 recover. Most patients are able to leave the hospital within a day or two.

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