Carotid Artery Disease

The gradual build-up of plaque in the carotid artery happens over time. The process is known as atherosclerosis, and can eventually cause the arteries to become stiff and narrow.

The causes of carotid artery disease include modifiable causes as well as non-modifiable causes.

Modifiable causes of carotid artery disease are:

• Diabetes, which affects the body’s ability to process fats thus increasing the risk for high blood pressure (hypertension) and atherosclerosis.
• High blood pressure or hypertension, which places additional pressure on the walls of arteries. This can cause artery walls to weaken or become damaged.
• High cholesterol, or high levels of low-density lipoprotein cholesterol (LDL) and high levels of triglycerides contribute towards the formation of plaque in the arteries.
• Obesity, which increases the risk of high blood pressure, atherosclerosis and diabetes.
• Sedentary lifestyle or lack of exercise contributes to chronic conditions such as high blood pressure, diabetes and obesity.
• Sleep apnoea or the intermittent interruption of breathing while sleeping, increases the risk for stroke.
• Smoking or tobacco use, which increases heart rate and pressure. In addition, nicotine irritates the inner lining of the arteries.

Non-modifiable causes of carotid artery disease are:

• Age, as the arteries are more likely to grow stiff and are more prone to injury.
• Gender, as men below 75 years have a higher risk compared to women in the same age group. However, the risk among women above 75 is greater than men in the same age group.
• Family history of the disease
• Those who suffer from coronary artery disease (hardening of the arteries supplying blood to the heart), which makes them more prone to developing carotid artery disease
• Previous neck radiotherapy

Carotid artery disease symptoms often go unnoticed until the blockage or narrowing is severe and this may result in a TIA. If you experience a TIA, your chances of experiencing a stroke increase by 10 times.

The symptoms of a TIA are temporary (may last a few minutes to a few hours), and they include any of the following:

• Difficulty swallowing
• Difficulty talking
• Numbness, tingling or weakness on one side of the face or body, or in one arm or leg.
• Sudden dizziness or confusion
• Sudden lack of coordination, balance and difficulty in walking
• Sudden loss of or blurred vision
• Sudden severe headache

It is important that you seek emergency help to receive immediate treatment to prevent the progression to a stroke.

Regular check-ups are important, especially if risk factors are present, as carotid artery disease can progress with no symptoms until a TIA occurs.

To screen for carotid artery disease, doctors can listen to the arteries in the neck with a stethoscope to detect an abnormal sound known as bruit. This is a sign of turbulent blood flow or narrowing of the carotid artery that could indicate carotid artery disease.

This may be confirmed by diagnostic tests such as:

• Ultrasound

  Ultrasound to assess blood flow and pressure in the carotid arteries

• CT or MRI scan

  CT or MRI scan to detect any abnormalities or evidence of stroke

• CT angiography or MR angiography

  CT angiography or MR angiography uses contrast dye for clearer images of blood flow in the carotid arteries.

Your doctor will evaluate your condition and discuss with you the carotid artery disease treatment options suitable for you. These may include a combination of lifestyle changes, medication and surgery.

Lifestyle changes include:

• Limit alcohol consumption
• Maintain a healthy diet
• Maintaining control of your blood pressure, diabetes and other heart diseases
• Quit smoking
• Exercise regularly

Medications

Medications are used to reduce the risk of stroke and other heart disease complications. These include:

• Antiplatelet medications to prevent excessive clotting
• Anticoagulant medications, also known as blood thinners, to slow the blood clotting process

Surgery

Surgery may be needed to unblock the artery and prevent future strokes, which include:

• Carotid endarterectomy (CEA)

  This procedure is performed under general anaesthesia. The surgeon makes an incision at the point of blockage, removes the plaque and repairs the damaged section, using a shunt or plastic tube to reroute blood flow to the brain, thus reducing the risk for stroke.

• Carotid angioplasty and stenting

  This is an alternative procedure for patients for whom surgery may be high risk or inadvisable. Performed under local anaesthesia, a balloon catheter is inflated at the point of the blockage to improve blood flow. This is usually followed by a stent or small metal mesh tube to keep the artery open.

The most common complications of carotid artery disease are:

• Transient ischemic attack (TIA)

  A TIA occurs when a blood flow to the brain is briefly disrupted. Also known as a mini stroke, the symptoms are similar to a stroke, but temporary. It is a warning sign that a stroke may occur if left untreated.

• Stroke

  A stroke means that blood supply to the brain has been partially or completely blocked, normally due to a blood clot or when a blood vessel ruptures. This can lead to long-term brain damage or death.