Carotid stenosis and carotid endarterectomy

What are the carotid arteries?

Arteries carry oxygen-rich blood away from the heart to the head and to the body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. The carotid arteries can be felt on each side of the lower neck, immediately below the angle of the jaw.

The carotid arteries supply blood to the large, front part of the brain where thinking, speech, personality, sensory and motor functions reside. The vertebral arteries run through the spine and supply blood to the back part of the brain (the brainstem and cerebellum).

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, is the narrowing of the carotid arteries, usually caused by atherosclerosis (a buildup of cholesterol and other substances traveling through the bloodstream). These substances stick to the blood vessel walls over time, and combine to form arterial “plaque”. This plaque buildup can then lead to narrowing or blockages within the carotid arteries, which can put the individual at increased risk for stroke.

What are the symptoms of carotid artery disease?

There may not be any symptoms of carotid artery disease, so the stenosis can be “asymptomatic”. If this is the case, often medical management will be sufficient to reduce your risk of stroke. However, carotid disease can also lead to warning signs of a future stroke. A transient ischemic attack (also called TIA or “mini-stroke”) is one of the most important warning signs. This occurs when a blood clot briefly blocks an artery that supplies blood to the brain, but does not cause a stroke. TIA can cause temporary symptoms such as those listed below. These can last a few minutes, a few hours, and can present alone or in combination:

• Sudden loss of vision or blurred vision in one or both eyes
• Weakness and/or numbness on one side of the face, arm or leg, or one side of the body
• Slurred speech, difficulty talking or understanding what others are saying
• Loss of coordination
• Dizziness or confusion
• Difficulty swallowing

A TIA is a medical emergency and assistance should be sought urgently. TIAs are strong predictors of potentially preventable future strokes in patients with carotid disease.

Diagnosis:

If there are no symptoms, carotid disease may be found incidentally on imaging (ultrasound, CT, or MRI). Carotid stenosis alone usually does not mean you will require an operation. If there are no symptoms from the carotid stenosis, the natural history is relatively benign and medical treatment (with medications and lifestyle modifications) is usually sufficient.

Of course, there are always exceptions, and decisions are made on a patient-by-patient basis. Factors such as the degree of carotid narrowing, the type of plaque / disease, your age, and multiple other factors influence whether you will benefit from a carotid endarterectomy. Dr Morrisroe will discuss your individual risk and benefit profile during your consultation.

If you have symptoms (see above); this is a time-critical condition and you will likely be offered an urgent carotid endarterectomy. Presentation to the emergency department will facilitate rapid investigation and treatment.