Carotid Artery Disease and Stroke
Oxygenated blood is carried from the heart to the face and brain by the carotid arteries one on each side of the neck. The carotid arteries (common) bifurcate and become the internal carotid artery (ICA) and the external carotid artery (ECA). Blood supply to the brain is mainly through the internal carotid artery and the vertebral arteries (1). Blood flow to the brain is affected by carotid artery disease. Carotid artery disease is the narrowing (stenosis) or blockage (occlusion) of the carotid arteries. Carotid artery disease is a common problem and a major cause of stroke. Carotid artery disease is caused by atherosclerosis (plaque) Atherosclerosis cannot be prevented, but the progression of the disease can be slowed or reduced through life style changes and diet (1). The best preventive measures are once again regular exercise, healthy diet, one that is low in cholesterol and saturated fat, maintaining a healthy body weight and not smoking (2). Factors that increase the risk of carotid artery disease: smoking, hypertension, diabetes, age, family hx, obesity, physical inactivity and high cholesterol (2). The most serious complication of carotid artery disease is stroke. Carotid artery disease increases the risk of stroke by several means.
• Reduced blood flow. A carotid artery may become so narrowed by atherosclerosis that not enough blood is able to reach portions of the brain.
• Ruptured plaque. A piece of plaque may break off and flow to the brain (cerebral arteries). This fragment may get stuck in one of the smaller arteries, creating a blockage that cuts off blood supply to that area of the brain causing a stroke.
• Blood clot blockage. Some plaques are prone to cracking and forming irregular surfaces on the artery wall. When this happens, the body treats it like an injury and sends platelets to the area. A blood clot can develop and block or slow the flow of blood through a carotid or cerebral artery, causing a stroke.
A stroke can leave a patient with permanent brain damage and muscle weakness. In severe cases, it can be fatal (3). To diagnose carotid artery disease, a physician may use a stethoscope to listen to the carotid arteries to detect a bruit (sound caused by turbulent flow in a narrowed artery). Depending on the results of patient history and the physical examination the doctor may order the following test: Carotid duplex ultrasound: transcranial Doppler ultrasound, CT scan, an MRA or arteriography (3)
The main goal of treating carotid artery disease is to prevent a stroke. The method of treatment depends on how narrow the arteries have become. In mild to moderate cases, simple lifestyle changes and medications may be sufficient to prevent stroke. If the blockage is severe or the patient has experienced a TIA or stroke, surgery or a stenting procedure may be necessary (4).
Medications: a daily aspirin or another blood-thinning medicine may be prescribed to prevent the formation of dangerous blood clots. ACE inhibitors, or calcium channel blockers may be used to control hypertension and a statin medication to lower cholesterol (4).
Procedures: when narrowing of a carotid artery is severe, or if the patient has had a stroke, it is common practice to open up the artery and remove the blockage. There are two ways to do this (3).
• Carotid endarterectomy. This is the most common treatment for severe carotid artery disease. This procedure is done under either local or general anesthesia. After making an incision along the front of the neck, the surgeon opens the affected carotid artery and removes the plaque. The artery is repaired with either stitches or a graft. Most people are discharged from the hospital within 48 hours after the operation. The risks are low, even in adults over 80 years old, as long as they are in good health. Studies have also shown that this type of surgery has lasting benefits and helps prevent strokes (3)....
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