An Overview of Carotid Artery Disease Sedentary lifestyle Family history of atherosclerosis, either coronary artery disease or carotid artery disease Men younger than age 75 have a greater risk than women in the same age group. Women have a greater risk than men older than age 75. People who have coronary artery disease have an increased risk of developing carotid artery disease. Typically, the carotid arteries become diseased a few years later than the coronary arteries. Continued What Are the Symptoms of Carotid Artery Disease? You may not have any symptoms of carotid artery disease. Plaque builds up in the carotid arteries over time with no warning signs until you have a transient ischemic attack (TIA) or a stroke. Signs of a stroke may include: Sudden loss of vision , blurred vision , or difficulty in seeing out of one or both eyes Weakness , tingling, or numbness on one side of the face, one side of the body, or in one arm or leg Sudden difficulty in walking, loss of balance, lack of coordination Sudden dizziness and/or confusion How Is Carotid Artery Disease Diagnosed?

There are often no symptoms of carotid artery disease until you have a TIA or stroke. That’s why it’s important to see your doctor regularly for physical exams. Your doctor may listen to the arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard over an artery, it may reflect turbulent blood flow. That could indicate carotid artery disease. Listening for a bruit in the neck is a simple, safe, and inexpensive way to screen for stenosis (narrowing) of the carotid artery, although it may not detect all blockages. Some experts believe that bruits may be better predictors of atherosclerotic disease rather than risk of stroke. Be sure to let your doctor know if you have had any symptoms, such as those listed above. Continued Your doctor may also use a test to diagnose carotid artery disease. Possible tests include the following: Carotid ultrasound (standard or Doppler). This noninvasive, painless screening test uses high-frequency sound waves to view the carotid arteries. It looks for plaques and blood clots and determines whether the arteries are narrowed or blocked.

A Doppler ultrasound shows the movement of blood through the blood vessels. Ultrasound imaging does not use X-rays. Magnetic resonance angiography (MRA). This imaging technique uses a powerful magnet to gather accurate information about the brain and arteries. Then a computer uses this information to generate high-resolution images. An MRA can often detect even small strokes in the brain. Computerized tomography angiography (CTA). More detailed than an X-ray, a CT uses X-rays and computer technology to produce cross-sectional images of the carotid arteries. Images of the brain can be collected as well. With this imaging test, the scan may reveal areas of damage on the brain. The CT scan uses a low level of radiation . Cerebral angiography ( carotid angiogram ). This procedure is considered the gold standard for imaging the carotid arteries. It is an invasive procedure that lets a doctor see blood flow through the carotid arteries in real time. Cerebral angiography allows the doctor to see narrowing or blockages on a live X-ray screen as contrast dye is injected in the carotid arteries. This procedure provides the best information. It does carry a small risk of serious complications. Continued Which Drugs Can Reduce the Risk of Stroke?

Your doctor may recommend antiplatelet medications such as aspirin and clopidogrel (Plavix) to decrease the risk of stroke caused by blood clots. Your doctor may also prescribe medications to lower cholesterol and blood pressure . In some cases, warfarin ( Coumadin ), a blood thinner , may be prescribed. What Medical Procedures Treat Carotid Artery Disease? If there is severe narrowing or blockage in the carotid artery, a procedure can be done to open the artery. This will increase blood flow to the brain to prevent future stroke. Your doctor may suggest either of the following procedures: Carotid endarterectomy (CEA). This has been the commonly performed procedure for patients who have carotid atherosclerosis and TIAs or mild strokes. While you’re under general anesthesia, an incision is made in the neck at the location of the blockage. The surgeon isolates the artery and surgically removes the plaque and diseased portions of the artery. Then, the artery is sewn back together to allow improved blood flow to the brain. The risks and benefits of CEA depend on your age, the degree of blockage, and whether you’ve had a stroke or TIA.

Carotid artery stenting (CAS). Carotid artery stenting (CAS) is a newer treatment option. It’s less invasive than carotid endarterectomy and is performed in a catheterization laboratory. With CAS, a small puncture is made in the groin. A specially designed catheter is threaded to the area of narrowing in the carotid artery. Once in place, a small balloon tip is inflated for a few seconds to open the artery. Then, a stent is placed in the artery and expanded to hold the artery open. A stent is a small tube that acts as a scaffold to provide support inside your artery. The stent is usually made of metal and is permanent. It can also be made of a material that the body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again. CAS is a newer procedure, and there is still some controversy as to how well it prevents strokes caused by carotid artery disease. Carotid Artery (Human Anatomy): Picture, Definition, Conditions, & More Next The carotid arteries are major blood vessels in the neck that supply blood to the brain, neck, and face.

There are two carotid arteries, one on the right and one on the left. In the neck, each carotid artery branches into two divisions: The internal carotid artery supplies blood to the brain. The external carotid artery supplies blood to the face and neck. Like all arteries, the carotid arteries are made of three layers of tissue: Intima, the smooth innermost layer Media, the muscular middle layer Adventitia, the outer layer The carotid sinus, or carotid bulb, is a widening of a carotid artery at its main branch point. The carotid sinus contains sensors that help regulate blood pressure. The carotid artery pulse can normally be felt in the neck by pressing the fingertips against the side of the windpipe, or trachea. Carotid Artery Conditions Carotid artery vasculitis : Inflammation of the carotid artery, due to an autoimmune condition or an infection. Stroke : A sudden blood clot in the carotid artery can interrupt blood flow to the brain, causing a stroke. Fragments of cholesterol plaque in the carotid artery may also travel into the brain to cause a stroke.

Carotid artery stenosis: Narrowing of the carotid artery, usually due to cholesterol plaque buildup, or atherosclerosis. Carotid artery stenosis does not usually cause symptoms until it becomes severe. Carotid artery aneurysm : A weak area of the carotid artery allows part of the artery to bulge out like a balloon with each heartbeat. Aneurysms pose a risk for breaking, which could result in stroke or severe bleeding, or hemorrhage. Carotid artery embolism: A fragment of cholesterol plaque, or embolus, may break off from the carotid artery wall and travel to the brain, causing a stroke. Carotid artery atherosclerosis : Cholesterol plaque may slowly build up in the carotid artery wall, over decades. The growing plaque may eventually narrow the carotid artery, known as stenosis, and can lead to a stroke. Amaurosis fugax: Temporary blindness in one eye, usually caused by a fragment of cholesterol plaque, or embolus, breaking off from the wall of the carotid artery. The embolus can get stuck in an artery supplying the eye, blocking blood flow.

Temporal arteritis : An autoimmune condition in which branches of the carotid artery become inflamed, known as vasculitis. Fever, a severe headache on one side of the head, and jaw pain when chewing can be symptoms. Carotid hypersensitivity syndrome: In a few people, applying pressure to the carotid sinus can cause fainting from a sudden drop in blood pressure. Symptoms may occur while shaving or wearing a tight shirt collar. Continued Carotid Artery Tests Carotid artery ultrasound : A probe placed against the skin reflects sound waves off the carotid artery, and a computer constructs images on a screen. Doppler ultrasound can be used to measure blood flow in the carotid artery, including any areas of narrowing, or stenosis. Carotid artery angiography , known as an angiogram: Contrast dye is injected into blood vessels, and X-rays are taken of the neck, revealing images of the carotid arteries. A narrowing, or stenosis, and a bulging, or aneurysm, in the carotid artery may be detected by angiography.

Computed tomography angiography (CTA scan): A CT scanner takes multiple X-rays, and a computer compiles them into images of the carotid artery and other arteries of the neck and brain. Contrast dye injected into the blood vessels can help reveal more details of the carotid arteries, such as narrowing or bulging, aiding diagnosis. Magnetic resonance angiography (MRA scan): An MRI scanner uses a high-powered magnet and a computer to create highly detailed images of the carotid artery and other arteries that supply the brain. MRA is superior to CT scanning in detecting strokes and most carotid artery problems. Carotid sinus massage : In a controlled setting, a doctor massages the neck directly over the carotid sinus. This maneuver may unmask carotid sinus problems and can be used to treat certain abnormal heart rhythms. Continued Carotid Artery Treatments Carotid endarterectomy : A surgery to open a narrowing, or stenosis, caused by cholesterol plaque in the carotid artery. A vascular surgeon cuts open the carotid artery, removes the plaque, and sews the artery closed. Statins : Cholesterol-lowering medicines taken in pill form daily.

Statins may reduce the risk of stroke and heart attack in some people with narrowing of the carotid artery, known as stenosis. Aspirin : In people at high risk for heart attack or stroke, a daily aspirin may reduce the risk of a future stroke or heart attack. Aspirin works by interfering with the components of blood that help blood to clot, known as platelets. Clopidogrel ( Plavix ): Clopidogrel may be used with or without aspirin in people at high risk for stroke or heart attack. Like aspirin, clopidogrel interferes with the components of blood that help blood to clot, known as platelets. Carotid artery stenting: A wire is moved through an artery in the leg up to the carotid artery, and a small wire tube, or stent is expanded inside a narrowing of the carotid artery. Carotid artery stenting can be performed in people with carotid artery stenosis who are poor candidates for endarterectomy. WebMD Image Collection Reviewed by Varnada Karriem-Norwood, MD on November 15, 2014 Sources What Is Carotid Artery Disease?

- NHLBI, NIH Share this page from the NHLBI on Blogger. Share this page from the NHLBI on Buzz. Share this page from the NHLBI on Delicious. Share this page from the NHLBI on Digg. Share this page from the NHLBI on Facebook. Add this link to the NHLBI to my browser. Email this page with Gmail. Bookmark this page with Google. Share this page from the NHLBI on LinkedIn. Share this page from the NHLBI on Messenger. Share this page from the NHLBI on MySpace. Share this page from the NHLBI on Reddit. Share this page from the NHLBI on Stumble. Share this page from the NHLBI on Tumblr. Share this page from the NHLBI on Twitter. What Is Carotid Artery Disease? Carotid artery disease is a disease in which a waxy substance called plaque builds up inside the carotid arteries. You have two common carotid arteries, one on each side of your neck. They each divide into internal and external carotid arteries. The internal carotid arteries supply oxygen-rich blood to your brain. The external carotid arteries supply oxygen-rich blood to your face, scalp, and neck.

Carotid Arteries Figure A shows the location of the right carotid artery in the head and neck. Figure B shows the inside of a normal carotid artery that has normal blood flow. Figure C show the inside of a carotid artery that has plaque buildup and reduced blood flow. Carotid artery disease is serious because it can cause a stroke , also called a “brain attack.” A stroke occurs if blood flow to your brain is cut off. If blood flow is cut off for more than a few minutes, the cells in your brain start to die. This impairs the parts of the body that the brain cells control. A stroke can cause lasting brain damage; long-term disability, such as vision or speech problems or paralysis (an inability to move); or death. Overview Carotid artery disease is a major cause of stroke in the United States. Over time, plaque hardens and narrows the arteries. This may limit the flow of oxygen-rich blood to your organs and other parts of your body. Atherosclerosis can affect any artery in the body. For example, if plaque builds up in the coronary (heart) arteries, a heart attack can occur.

If plaque builds up in the carotid arteries, a stroke can occur. A stroke also can occur if blood clots form in the carotid arteries. This can happen if the plaque in an artery cracks or ruptures. Blood cell fragments called platelets (PLATE-lets) stick to the site of the injury and may clump together to form blood clots. Blood clots can partly or fully block a carotid artery. A piece of plaque or a blood clot also can break away from the wall of the carotid artery. The plaque or clot can travel through the bloodstream and get stuck in one of the brain's smaller arteries. This can block blood flow in the artery and cause a stroke. Carotid artery disease may not cause signs or symptoms until the carotid arteries are severely narrowed or blocked. For some people, a stroke is the first sign of the disease. Outlook Carotid artery disease is a major cause of stroke in the United States. Other conditions, such as certain heart problems and bleeding in the brain, also can cause strokes. Lifestyle changes, medicines, and medical procedures can help prevent or treat carotid artery disease and may reduce the risk of stroke.

If you think you're having a stroke, you need urgent treatment. Call 9–1–1 right away if you have symptoms of a stroke. Do not drive yourself to the hospital. You have the best chance for full recovery if treatment to open a blocked artery is given within 4 hours of symptom onset. The sooner treatment occurs, the better your chances of recovery. Rate This Content: Checking pulse over the carotid artery - Mayo Clinic Sign up now Checking pulse over the carotid artery To check your pulse over your carotid artery, place your index and middle fingers on your neck to the side of your windpipe. When you feel your pulse, look at your watch and count the number of beats in 10 seconds. Multiply this number by 6 to get your heart rate per minute. Carotid Artery Disease - National Library of Medicine - PubMed Health Extracranial‐intracranial arterial bypass surgery for occlusive carotid artery disease Patients with symptomatic occlusion (obstruction) of the carotid artery have a high risk of subsequent stroke.

Anticoagulant treatment and antiplatelet agents are not very effective in these patients and a surgical procedure known as extracranial‐intracranial (EC/IC) arterial bypass surgery has been a treatment option. In this review, we included 21 trials (two randomised controlled trials and 19 non‐random studies, with a total of 2591 patients). We found that EC/IC bypass surgery in patients with symptomatic carotid artery occlusive disease was no better or worse than medical care alone. A multi‐centre trial comparing EC/IC bypass surgery with best medical treatment in patients with both a high risk of stroke and haemodynamic compromise (impaired blood flow) is underway, and aims to discover whether EC/IC bypass surgery is beneficial in this specific group of patients. Carotid endarterectomy for carotid stenosis in patients selected for coronary artery bypass graft surgery People who have coronary artery disease requiring coronary artery bypass graft (CABG) surgery often have narrowing of other arteries.

If the carotid artery, the artery carrying blood to the brain, is narrow (called carotid stenosis), this may increase the risk of stroke and other brain damage, complicating CABG surgery. Surgery to remove the carotid narrowing might prevent these complications of CABG surgery, but also has risks. We found no reliable evidence from randomised trials to indicate whether or not to perform preventive carotid surgery in patients who are going to have CABG surgery. Extracranial‐intracranial arterial bypass surgery for occlusive carotid artery disease Patients with symptomatic occlusion (obstruction) of the carotid artery have a high risk of subsequent stroke. Anticoagulant treatment and antiplatelet agents are not very effective in these patients and a surgical procedure known as extracranial‐intracranial (EC/IC) arterial bypass surgery has been a treatment option. In this review, we included 21 trials (two randomised controlled trials and 19 non‐random studies, with a total of 2591 patients). We found that EC/IC bypass surgery in patients with symptomatic carotid artery occlusive disease was no better or worse than medical care alone.

A multi‐centre trial comparing EC/IC bypass surgery with best medical treatment in patients with both a high risk of stroke and haemodynamic compromise (impaired blood flow) is underway, and aims to discover whether EC/IC bypass surgery is beneficial in this specific group of patients. Carotid endarterectomy for carotid stenosis in patients selected for coronary artery bypass graft surgery People who have coronary artery disease requiring coronary artery bypass graft (CABG) surgery often have narrowing of other arteries. If the carotid artery, the artery carrying blood to the brain, is narrow (called carotid stenosis), this may increase the risk of stroke and other brain damage, complicating CABG surgery. Surgery to remove the carotid narrowing might prevent these complications of CABG surgery, but also has risks. We found no reliable evidence from randomised trials to indicate whether or not to perform preventive carotid surgery in patients who are going to have CABG surgery. Drugs and pacemakers for transient loss of consciousness Neurally mediated reflex syncope (including fainting) is the most common cause of transient loss of consciousness. It is caused by a sudden decrease in blood pressure and/or lowering of heart rate.

The main treatment goal therefore is to increase blood pressure and heart rate. In most patients, this can be achieved by non‐pharmacological treatment measures (e.g. adequate fluid and salt intake, physical counterpressure manoeuvres). In patients not responding to this treatment, pharmacological or pacemaker treatment might be considered. We investigated the effectiveness of these treatments for different subtypes of neurally mediated reflex syncope, namely vasovagal syncope (fainting), carotid sinus syncope (fainting due to pressure on the neck) and situational syncope (fainting when passing urine of faeces or swallowing). Where data were available, we determined the treatment effectiveness for different outcome measures including occurrence of syncope, amount of (pre‐)syncopes per year during follow‐up and quality of life. Carotid stenosis | carotid artery disease Carotid stenosis (carotid artery disease) Overview Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain.

Also called carotid artery disease, carotid stenosis is caused by a buildup of plaque (atherosclerosis) inside the artery wall that reduces blood flow to the brain. Treatment aims to reduce the risk of stroke by controlling or removing plaque buildup and preventing blood clots. Blood supply of the brain To understand carotid stenosis, it is helpful to understand the circulatory system of the head and neck (see Anatomy of the Brain ). The carotid artery begins at the aorta in the chest as the common carotid and courses up through the neck to the head. Place your hands on either side of your neck, and you can feel your pulse in your carotid arteries. Near the larynx, the common carotid divides into the external and internal carotid arteries. The external carotid arteries supply blood to the face and scalp. The internal carotid arteries supply blood to the brain. The most common location of atherosclerotic plaque buildup is the carotid bifurcation (Fig. 1), where the common carotid divides into the internal and external carotid arteries. Figure 1. The common carotid artery divides into the internal and external carotid arteries.

The bifurcation (green circle) is the most common site of atherosclerosis plaque buildup. What is carotid stenosis? Carotid stenosis is a progressive narrowing of the carotid arteries in a process called atherosclerosis. Normal healthy arteries are flexible and have smooth inner walls. As we age, hypertension and small injuries to the blood vessel wall can allow plaque to build up. Plaque is a sticky substance made of fat, cholesterol, calcium, and other fibrous material. Over time, plaque deposits inside the inner wall of the artery can form a large mass that narrows the lumen, the inside diameter of the artery. Atherosclerosis also causes arteries to become rigid, a process often referred to as "hardening of the arteries." Figure 2. A. Atherosclerotic plaque narrows the artery diameter, reducing blood flow. B. The irregular surface of the artery wall can cause clot formation that blocks the vessel or breaks off, travels downstream, and blocks a smaller vessel. There are three ways in which carotid stenosis increases the risk of stroke: Plaque deposits can grow larger and larger, severely narrowing the artery and reducing blood flow to the brain.

Plaque can eventually completely block (occlude) the artery (Fig. 2A). Plaque deposits can roughen and deform the artery wall, causing blood clots to form and blocking blood flow to the brain (Fig. 2B). Plaque deposits can rupture and break away, traveling downstream to lodge in a smaller artery and block blood flow to the brain. What are the symptoms? Most people with carotid stenosis have no symptoms until the artery becomes severely narrowed or a clot forms. Symptoms are most likely to first appear with a mini-stroke, also known as a transient ischemic attack (TIA). TIAs result when blood flow to the brain is temporarily interrupted and then restored. The symptoms typically last a couple of minutes and then resolve completely, and the person returns to normal. TIAs should not be ignored; they are a warning that an ischemic stroke and permanent brain injury may be looming. Symptoms of a TIA or an ischemic stroke can include weakness or numbness in an arm or leg, difficulty speaking, a drooping face, vision problems, or paralysis affecting one side of the body. If you or a loved one develops these symptoms, you should call 911 immediately. What are the causes?

Atherosclerosis is the major cause of carotid artery disease. It can begin in early adulthood, but it usually takes decades to cause symptoms. Some people have rapidly progressing atherosclerosis during their thirties, others during their fifties or sixties. Atherosclerosis begins with damage to the inner wall of the artery caused by high blood pressure, diabetes, smoking, and high cholesterol –specifically "bad" cholesterol or low-density lipoprotein (LDL). Other risk factors include obesity, coronary artery disease, a family history of carotid stenosis, and advanced age. Less commonly, carotid aneurysm and fibromuscular dysplasia can cause carotid stenosis. People who have heart disease have an increased risk of developing carotid stenosis. Typically, the carotid arteries become diseased a few years later than the coronary arteries. Who is affected? Older people are more likely to be affected by carotid stenosis. Before age 75, men are more at risk than women. A person who has high cholesterol, has high blood pressure, and smokes is eight times more likely to develop atherosclerosis than a person without these risk factors.

More than 500,000 new strokes occur in the United States each year, and carotid stenosis is estimated to cause 20 to 30% of them. How is a diagnosis made? Your doctor will learn as much as possible about your symptoms, current and previous medical problems, current medications, and family history. He or she will perform a physical exam. The doctor may listen to the carotid artery with a stethoscope to detect a swishing noise called a "bruit." A bruit may be a sign of turbulent blood flow caused by atherosclerosis. One or more diagnostic tests are performed to detect narrowing of the carotid arteries. Carotid stenosis is diagnosed by either a doppler ultrasound of the neck, a CT angiogram (CTA) of the neck, magnetic resonance angiography (MRA), or a cerebral angiogram. Imaging also can reveal evidence of multiple small strokes. Doctors can make a diagnosis of carotid stenosis if tests show diminished blood flow in one or both carotid arteries. You may be referred to a neurosurgeon for a surgical consultation. Figure 3.

Doppler ultrasound of the carotid artery showing a narrowed artery lumen. Doppler ultrasound is a noninvasive test that uses reflected sound waves to evaluate blood flow through a vessel (Fig. 3). The ultrasound probe is placed on the neck over the carotid arteries. This test will reveal how much blood is flowing through the artery and to what degree the artery has narrowed (i.e., 100%, 80%, 70%, etc.). Computed Tomography Angiography , or a CT angiogram, is a noninvasive X-ray that provides detailed images of anatomical structures within the brain. It involves injecting a contrast agent into the blood stream so that arteries of the brain can be seen. This type of test provides the best pictures of both blood vessels (through angiography) and soft tissues (through CT). It enables doctors to see the narrowed artery and to determine how much it has narrowed. Magnetic Resonance Angiography (MRA) of the neck is similar to the CT angiogram. Contrast dye is injected through an IV to illuminate blood vessels in the neck.

Cerebral Angiogram is a minimally invasive test that uses X-rays and a contrast agent injected into the arteries through a catheter in the groin. It enables doctors to visualize all arteries in the brain (Fig. 4). Figure 4. Angiogram of the carotid artery showing a narrowing of the vessel caused by atherosclerotic plaque (red arrow). What treatments are available? The goal of treatment is to reduce the risk of stroke. Treatment options for carotid stenosis vary according to the severity of the arterial narrowing and whether you are experiencing stroke-like symptoms or not (asymptomatic). Medications People who have no symptoms or who have low-grade carotid stenosis of less than 50% are usually treated with medications [1,3]. People who have a medical condition that would increase the risk of surgery also are likely to be treated with medication. Medications include antiplatelets, cholesterol-lowering statins, and antihypertensives. Antiplatelet medications (aspirin, ticlopidine, clopidogrel) thin the blood and prevent clotting in the narrowed arteries, which allows blood to pass through more easily.

Cholesterol-lowering statins help reduce plaque formation in atherosclerosis. Statins can reduce LDL "bad" cholesterol by an average of 25-30% when combined with a low-fat, low-cholesterol diet. Antihypertensive medications (diuretics, ACE inhibitors, angiotensin blockers, beta blockers, calcium channel blockers, etc.) help control and regulate blood pressure. Because high blood pressure is a major risk of stroke, regular blood pressure screenings are recommended. Surgery Surgical treatment is generally recommended for patients who have suffered one or more TIAs or strokes and who have a moderate to high grade of carotid stenosis [2,3]. The aim of surgery is to prevent stroke by removing or reducing the plaque buildup and enlarging the artery lumen to allow more blood flow to the brain. Carotid endarterectomy is a surgical procedure to remove the plaque. A skin incision is made in the neck and the carotid artery is located. Temporary clamps are placed across the artery above and below the area of stenosis to stop blood flow. During this time, the carotid artery on the other side of the neck carries blood flow to the brain.

The surgeon makes an incision in the artery over the blocked area. The plaque buildup is physically peeled out and removed (Fig. 5). The artery is then closed with tiny sutures and the clamps removed to allow blood flow to the brain. Carotid endarterectomy is typically indicated for patients who have had symptoms (stroke or TIA) and have blockage greater than 50%. It is also recommended for patients who have no symptoms (asymptomatic) and have blockage greater than 60%. Among patients with moderate blockage of 50 to 69%, surgery reduces the risk of stroke by 6.5% over a five-year period. Among patients with high-grade blockage of more than 70%, the risk of stroke is reduced by 80% [2]. The benefit of endarterectomy for patients whose stenosis is 50% or less does not outweigh the risks of the procedure. Carotid angioplasty / stenting is a minimally invasive endovascular procedure that compresses the plaque and widens the lumen of the artery. It is performed during an angiogram in an interventional radiology suite.

A flexible catheter is advanced from the femoral artery in the groin, past the heart, and to the location of the plaque within the carotid artery. Next, a small catheter with an inflatable balloon at the tip is positioned across the plaque. When the balloon is opened, it dilates the artery and compresses the plaque against the arterial wall. The balloon is then deflated and removed. Finally, a self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery. Angioplasty / stenting is typically indicated for select patients who 1) have moderate to high-grade carotid stenosis greater than 70%; 2) have other medical conditions that increase the risk of surgical complications; 3) have recurrent stenosis; or 4) have stenosis that was caused by prior radiation therapy [3]. Carotid artery bypass is a surgical procedure that reroutes the blood supply around the plaque-blocked area. A length of artery or vein is harvested from somewhere else in the body, usually the saphenous vein in the leg or the ulnar or radial arteries in the arm.

The vessel graft is connected above and below the blockage so that blood flow is rerouted (bypassed) through the graft. Bypass is typically only used when the carotid is 100% blocked (carotid occlusion). Clinical trials Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see clinicaltrials.gov ) as well as private industry and pharmaceutical companies (see ). Recovery & prevention Depending on your risk factors, your physician may ask you to stop smoking, limit heavy alcohol consumption, maintain good blood-sugar control (if you have diabetes), have your cholesterol checked regularly, and take medications as prescribed. It’s important to remember that carotid stenosis is a progressive disease.

If left untreated, carotid stenosis has a stroke rate of 13% per year [3] in people with symptoms and 2.2% per year [1] in people without symptoms. Do not ignore the early warning signs! After carotid endarterectomy, restenosis can occur in less than two years and is usually not symptomatic. These regrown plaques can be treated with angioplasty and stenting. The plaques may regress with time, and intervention is reserved for stenosis greater than 80%. After two years, restenosis is more often related to progression of atherosclerotic disease. In general, repeat surgery or stenting is advised for symptomatic restenosis or stenosis greater than 80%. Sources & links If you have more questions, please contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100. For information about the University of Cincinnati Neuroscience Institute’s Stroke Center, call 866-941-8264. Sources Executive Committee for the Asymptomatic Carotid Atherosclerosis Study.

Endarterectomy for Asymptomatic Carotid Artery Stenosis. JAMA 273:1421-28, 1995 Barnett HJ, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 339(20):1415-25, 1998 Hobson RW 2nd, et al.; Society for Vascular Surgery. Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 48(2):480-6, 2008 Links Glossary angioplasty: an endovascular procedure with a balloon-tipped catheter to enlarge a narrowing in an artery. atherosclerosis: a disease of the arterial blood vessels, in which the walls of the arteries become thickened and hardened by plaques.

Plaques are composed of cholesterol and other lipids, inflammatory cells, and calcium deposits; also called "hardening of the arteries." cholesterol: a fat-like substance that is made by the human body and eaten in animal products. Cholesterol is used to form cell membranes and process hormones and vitamin D. High cholesterol levels contribute to the development of atherosclerosis. endarterectomy: a surgical procedure in which material occluding the carotid artery is cleaned out, thereby restoring normal blood flow to the brain and preventing a stroke. fibromuscular dysplasia: abnormal cell growth in the artery walls that causes narrowing and a "string of beads" appearance; usually affects arteries of the kidneys and brain. hemorrhagic stroke: stroke caused by the rupture of a blood vessel in the brain. ischemic stroke: a stroke caused by an interruption or blockage of oxygen-rich blood flow to an area of the brain; caused by a blood clot, atherosclerosis, vasospasm, or reduced blood pressure. LDL cholesterol: Low-density lipoprotein cholesterol is the primary cholesterol molecule. High levels of LDL, nicknamed "bad" cholesterol, increase the risk of atherosclerosis. lumen: the inside diameter of a blood vessel or hollow organ.

occlusion: an obstruction or closure of a passageway or vessel. stent: a tube-like device that is inserted into a vessel or passageway to keep it open. transient ischemic attack (TIA): a "mini" stroke caused when blood flow to the brain is temporarily interrupted and then restored; causes no permanent brain damage. updated > 4.2016 reviewed by > Andrew Ringer, MD , Mayfield Clinic / University of Cincinnati Department of Neurosurgery, Ohio Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider. Mayfield services Mayfield Clinic treats more than 140 people with carotid artery disease each year. Rapid treatment of plaque buildup (atherosclerosis) in the carotid arteries can greatly reduce the risk of stroke. Our neurosurgeons and endovascular surgeons perform endarterectomy, balloon angioplasty / stenting, and carotid artery bypass. We are one of the largest treatment and research centers for diseases involving the blood vessels of the brain (cerebrovascular diseases).

Through our affiliation with the University of Cincinnati Comprehensive Stroke Center, Precision Radiotherapy, and other premier hospitals in the Greater Cincinnati / Northern Kentucky area. To make an appointment call 513-221-1100. Carotid Artery Disease - Texas Heart Institute Heart Information Center Carotid Artery Disease Related terms: cerebrovascular disease, stroke, transient ischemic attack (TIA) Carotid artery disease affects the vessels leading to the head and brain (cerebrovascular disease). Like the heart, the brain's cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when the carotid arteries become blocked and the brain does not get enough oxygen. Carotid artery disease increases the risk of stroke in 3 ways: By fatty deposits called plaque severely narrowing the carotid arteries. By a blood clot becoming wedged in a carotid artery narrowed by plaque.

By plaque breaking off from the carotid arteries and blocking a smaller artery in the brain (cerebral artery). Who is at risk for carotid artery disease and stroke? About every 4 minutes, somebody in the United States dies of a stroke. The older you are, the greater your risk of stroke, and more men than women have strokes. Stroke is the number 5 killer in the United States, and a leading cause of disability among older Americans. See also on this site: Stroke If you have carotid artery disease, you probably also have severe coronary artery disease or have a parent who died from coronary artery disease. So, the risk factors for carotid artery disease are similar to those for coronary artery disease: High levels of low-density lipoprotein cholesterol (bad cholesterol) and triglycerides in the blood. High blood pressure Family history of coronary artery disease Obesity Lack of exercise What are the symptoms of carotid artery disease? Although there are no symptoms specific to carotid artery disease, the warning signs of a stroke are a good way to tell if there is a blockage in the carotid arteries.

Transient ischemic attacks (TIAs) are one of the most important warning signs that you may soon have a stroke. Sometimes called "mini-strokes," TIAs are temporary episodes of headache, dizziness, tingling, numbness, blurred vision, confusion, or paralysis that can last anywhere from a few minutes to a couple of hours. See a doctor right away if you or someone you know has the symptoms of a TIA. Other signs or symptoms of a carotid artery blockage may be Weakness or paralysis of your arm, leg, or face on one side of your body. Numbness or tingling of your arm, leg, or face on one side of your body. Trouble swallowing. Loss of eyesight or blurry eyesight in one eye. Dizziness, confusion, fainting, or coma. Sudden, severe headache with no known cause. How is carotid artery disease diagnosed? In most cases, doctors can tell if you have the disease during a normal checkup. Your doctor may ask if you have had symptoms of a stroke (muscle weakness or numbness, lightheadedness, or trouble talking or seeing).

By placing a stethoscope over the carotid artery in your neck, your doctor can listen for a rushing sound, called a bruit (pronounced "brew-ee"). But, the results of this test can be misleading. Bruit sounds may not always be present, even when carotid artery disease is severe. Also, bruit sounds are sometimes heard when blockages are only minor. Other diagnostic tools include Doppler ultrasound imaging , which uses sound waves to check blood flow and measure the thickness of your carotid arteries. Magnetic Resonance Angiography (MRA), which is a type of magnetic resonance imaging that uses harmless but powerful magnetic fields to give a detailed picture of the arteries in your brain. Oculoplethysmography, which measures the pulsation of the arteries in the back of your eye, as an indirect check for blockages in the carotid arteries. Arteriography and digital subtraction angiography (DSA), which takes X-ray pictures of the carotid artery after a special dye is injected into your bloodstream. Doppler ultrasound or "echo" study How is carotid artery disease treated?

In addition to treating atherosclerosis or other underlying disorders, lifestyle changes, medicines, percutaneous interventions, or surgery may be needed to offset the effects of carotid artery disease and lower the risk of stroke. Lifestyle Changes Treatment for carotid artery disease includes lifestyle changes. The National Stroke Association recommends that you Quit smoking. See a doctor right away if you have symptoms of stroke. Medicines Blood-thinning medicines (called anticoagulants) may be needed to prevent stroke. Blood-thinning medicines and aspirin have been shown to lessen the risk of stroke. In most cases, patients will need to take these medicines for the rest of their lives. Percutaneous Interventions Interventional cardiologists may perform carotid artery angioplasty to open clogged carotid arteries. They use a long, thin tube called a catheter that has a small balloon on its tip. They inflate the balloon at the blockage site in the carotid artery to flatten or compress the plaque against the artery wall. Carotid angioplasty is often combined with the placement of a small, metal, mesh-like device called a stent.

When a stent is placed inside of a carotid artery, it acts as a support or scaffold, keeping the artery open. Carotid angioplasty and stenting are usually performed in patients either because they are not candidates for the traditional surgery (carotid endarterectomy) or because the procedure is felt to be less risky than the traditional surgery. Surgery Carotid endarterectomy removes fatty plaque from neck arteries. See also on this site: Carotid artery surgery: MedlinePlus Medical Encyclopedia URL of this page: //medlineplus.gov/ency/article/002951.htm Carotid artery surgery Carotid artery surgery is a procedure to restore proper blood flow to the brain. The carotid artery brings needed blood to your brain and face. You have one of these arteries on each side of your neck. Blood flow in this artery can become partly or totally blocked by fatty material called plaque. This can reduce the blood supply to your brain and cause a stroke. There are 2 procedures to treat a carotid artery that has plaque buildup in it. This article focuses on a surgery called endarterectomy. The other method is called angioplasty with stent placement .

Description During carotid endarterectomy: You receive general anesthesia . You are asleep and pain free. Some hospitals use local anesthesia instead. Only the part of your body being worked on is numbed with medicine so that you do not feel pain. You are also given a medicine to help you relax. You lie on your back on an operating table with your head turned to one side. The side your blocked carotid artery is on faces up. The surgeon makes a cut (incision) on your neck over your carotid artery. A flexible tube (catheter) is put in the artery. Blood flows through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes the plaque inside the artery. After the plaque is removed, the artery is closed with stitches. Blood now flows through the artery to your brain. Your heart activity will be monitored closely during surgery. The surgery takes about 2 hours. After the procedure, your doctor may do a test to confirm that the artery has been opened. Why the Procedure is Performed This procedure is done if your doctor has found narrowing or a blockage in your carotid artery.

Your doctor will have done one or more tests to see how much the carotid artery is blocked. Surgery to remove the buildup in your carotid artery may be done if the artery is narrowed by more than 70%. If you have had a stroke or temporary brain injury, your doctor will consider whether treating your blocked artery with surgery is safe for you. Other treatment options your doctor will discuss with you are: No treatment, other than tests to check your carotid artery every year. Medicine and diet to lower your cholesterol. Blood-thinning medicines to lower your risk of stroke. Some of these medicines are aspirin, clopidogrel (Plavix), and warfarin (Coumadin). Carotid angioplasty and stenting is likely to be used when carotid endarterectomy would not be safe. Risks Carotid Ultrasound - NHLBI, NIH Carotid Ultrasound Share this page from the NHLBI on Blogger. Share this page from the NHLBI on Buzz. Share this page from the NHLBI on Delicious. Share this page from the NHLBI on Digg. Share this page from the NHLBI on Facebook. Add this link to the NHLBI to my browser.

Email this page with Gmail. Bookmark this page with Google. Share this page from the NHLBI on LinkedIn. Share this page from the NHLBI on Messenger. Share this page from the NHLBI on MySpace. Share this page from the NHLBI on Reddit. Share this page from the NHLBI on Stumble. Share this page from the NHLBI on Tumblr. Share this page from the NHLBI on Twitter. Carotid Ultrasound Also known as carotid duplex. Carotid ultrasound is a painless imaging test that uses high-frequency sound waves to create pictures of the inside of your carotid arteries. This test uses an ultrasound machine, which includes a computer, a screen, and a transducer. The transducer is a handheld device that sends and receives sound waves. If combined with Doppler ultrasound, this test also can show how blood is moving through your arteries. Carotid ultrasound is done to detect plaque buildup in one or both of the carotid arteries in the neck and to see whether the buildup is narrowing your carotid arteries and blocking blood flow to the brain. Test results will help your doctor plan treatment to remove the plaque and help prevent a stroke.

Carotid ultrasound usually is done in a doctor’s office or hospital. You will lie on your back on an exam table for your test. The ultrasound technician will put gel on your neck where your carotid arteries are located. The gel helps the sound waves reach your arteries. The technician will move the transducer against different areas on your neck. The transducer will detect the sound waves after they have bounced off your artery walls and blood cells. A computer will use the sound waves to create and record pictures of the inside of your carotid arteries and to show how blood is flowing in your carotid arteries. Carotid ultrasound has no risks because the test uses harmless sound waves. They are the same type of sound waves that doctors use to create and record pictures of a baby inside a pregnant woman. Visit Carotid duplex for more information about this topic.

Question: Where would you find the carotid arteries?
Answer: Neck