The major blood supply to the brain is supplied by the carotid arteries, which are located on either side of the neck. An artery is normally smooth, allowing blood to flow freely. Arteries may become blocked by atherosclerosis or “hardening of the arteries.” Although you may not have symptoms, your doctor or health care provider may listen to your neck and hear a “bruit,” which is due to turbulent blood flow.
Ulcers may also form inside the artery. These ulcers have a rough surface which may cause particles of atherosclerosis or blood clots to break loose into the circulation to the eye or brain. These may cause a TIA (mini stroke) or stroke. We as a team are able to diagnose, evaluate, and treat carotid artery disease.
Ultrasound: This type of test uses ultrasound to send high frequency sound waves into the artery which are reflected by moving red blood cells. The vascular technician will place a hand held transducer (probe) on your skin with some gel to perform the test. This test takes about fifteen minutes to complete. You may eat and drink before the exam and take your usual dose of medications unless instructed otherwise.
Magnetic Resonance Angiography (MRA): This test is often used to check for blockages of the arteries in your neck. It uses a large scanner with a powerful magnetic field to produce images based primarily on the water content of the body’s fluids, organs, and tissues. This test cannot be done on people who have metal implants, such as metal plates, pacemakers, orthopedic screws, or cerebral aneurysm clips. It is okay if you have fillings in your teeth, however you must remove any jewelry or watches before the test. You may or may not have contrast injection through an IV (intravenous catheter).
Computerized Tomography Angiogram (CTA Scan): This test evaluates the carotid arteries and degree of stenosis. This is the same preparation as the above test except you will have intravenous contrast injected through an intravenous line. If you have renal insufficiency (trouble with your kidneys) other precautions will be taken as well.
Invasive Arterial Testing
Angiogram: An angiogram is an x-ray of your arteries. This test is done to determine the exact location of disease within your arteries. It is performed by a team of physicians, physician assistants, nurses and technicians. You will meet with the radiologist before the test who will review the procedure and possible side effects and ask you to sign a consent form. Blood work is drawn before the test to determine the ability of your blood to clot and your kidney function.
Vascular related medical treatments used in caring for patients with carotid artery disease (CAD) include many options. One treatment that is strongly recommended would be changes in lifestyle, especially ones that can begin at home. Many risk factors with CAD include: age, smoking, high blood pressure, high cholesterol, diabetes, obesity, a sedentary lifestyle, and a family history. While family history and age cannot be controlled, taking control of your lifestyle can make a difference.
Some patients may also need to take medicine prescribed by their doctor to help increase blood flow in the carotid arteries and decrease the risk of stroke. These may include medications to help lower one’s cholesterol or blood pressure, anti-platelet medicines, such as Plavix (Clopidogrel), or aspirin, or blood thinners like Coumadin (Warfarin).
Minimally Invasive Treatment
Improving the blood flow in the carotid arteries may be necessary to also decrease one’s risk of having a stroke. One minimally invasive treatment used is carotid artery stenting (CAS). Stenting of the carotid arteries is an evolving minimally invasive approach for treatment of carotid artery stenosis. Through new innovations, research techniques, and National Institute of Health trials, we are able to offer this advanced intervention on select patients.
Carotid stenting is generally considered for patients with recurrence of stenosis after previous carotid surgery, previous neck surgery, and/or radiation to the neck region. The procedure consists of a small puncture made in the groin where a specially designed catheter is threaded up to the narrowing of the artery. Once in place, a small balloon tip is then inflated for a few seconds to open up the artery. Then, a stent is placed in the artery and expanded to hold the artery open and increase the blood flow to the brain.
Acarotid endarterectomy (CEA) may be used to treat CAD. This procedure is commonly performed when carotid stenosis is significant secondary to atherosclerosis (fatty build up in the artery walls) and TIA’s (transient ischemic attacks, aka “mini strokes”) have occurred.
The procedure is done in the operating room, under local anesthesia. An incision is made in the neck, the surgeon isolates the artery and surgically removes the plaque build up in the affected area. Then, the artery is sewn back together. The procedure requires an overnight stay in the hospital.