The carotid arteries are major blood vessels in your neck that deliver oxygen-rich blood from the heart to the brain. When these arteries narrow due to plaque buildup, a condition known as carotid artery blockage or carotid stenosis occurs. This plaque, composed of fatty cholesterol deposits, can restrict blood flow and elevate the risk of a stroke.
Detecting Carotid Artery Blockage
Healthcare providers use various methods to diagnose and measure carotid artery blockages. A common diagnostic tool is the carotid ultrasound, also known as a duplex scan. This painless test uses sound waves to create images of the arteries, assess blood flow, and determine the degree of blockage.
Other imaging tests, such as CT angiography (CTA) and MR angiography (MRA), can confirm the diagnosis. CTA uses X-rays with a contrast dye for detailed artery images, while MRA uses magnetic fields and radio waves to visualize blood vessels. These tests provide essential information, including the percentage of artery narrowing, which guides treatment decisions.
When Surgery is Considered
The decision for carotid artery surgery depends on several factors, including the percentage of narrowing and patient symptoms. For individuals with symptoms like a transient ischemic attack (TIA) or a minor stroke, the threshold for surgical intervention is generally lower. Symptoms indicate the blockage is actively affecting blood flow to the brain, increasing the urgency for intervention.
Symptomatic patients with carotid artery stenosis of 70% to 99% often benefit from surgery. Blockages between 50% and 69% may also warrant surgery in symptomatic cases. Early intervention, ideally within two weeks of symptom onset, can provide greater benefit.
For patients with carotid artery blockage but no symptoms, surgical criteria are typically more stringent. Surgery is generally considered for asymptomatic individuals with carotid artery stenosis of 60% or greater. This decision balances the risk of future stroke against potential surgical risks. Other considerations include the patient’s overall health, life expectancy, and the presence of other medical conditions like heart disease or diabetes.
Surgical Options for Carotid Blockage
Two primary procedures are available to address carotid artery blockage. Carotid endarterectomy (CEA) is a traditional open surgical approach where plaque is removed from the carotid artery. During this procedure, an incision is made in the neck to expose the artery, which is opened to remove plaque. After removal, the artery is closed, often with a patch to widen the vessel and prevent future narrowing.
Carotid artery stenting (CAS) offers a less invasive alternative. This procedure involves inserting a catheter, typically through an artery in the groin, and guiding it to the narrowed carotid artery. A balloon at the catheter’s tip is inflated to widen the artery, and a stent is placed to keep it open. The choice between CEA and CAS depends on patient factors and the surgeon’s assessment of the best outcome with the lowest risk.
Managing Carotid Artery Disease Without Surgery
For individuals not meeting surgical criteria or with milder blockages, medical management and lifestyle adjustments are primary treatment approaches. Medications stabilize the condition and prevent progression. Antiplatelet drugs, such as aspirin or clopidogrel, prevent blood clots.
Cholesterol-lowering medications, particularly statins, decrease cholesterol levels and stabilize existing plaque. Blood pressure medications manage hypertension, as high blood pressure contributes to artery damage. These treatments aim to reduce stroke risk.
Beyond medication, lifestyle modifications are crucial for managing carotid artery disease. Quitting smoking is advised, as tobacco damages blood vessels and promotes plaque buildup. Adopting a heart-healthy diet, rich in fruits, vegetables, and lean proteins while limiting saturated fats and cholesterol, also supports arterial health. Regular exercise, maintaining a healthy weight, and managing conditions like diabetes slow the disease’s progression. Periodic follow-up appointments and imaging tests monitor the blockage and assess non-surgical strategies.