Carotid Artery Disease

Carotid artery disease often does not cause symptoms, but there are tests that can tell your doctor if you have it. If the arteries are very narrow, you may need an operation called an endarterectomy to remove the plaque. For less severe narrowing, a medicine to prevent blood clots can reduce your risk of stroke. Another option for people who can’t have surgery is carotid angioplasty. This involves placing balloons and/or stents into the artery to open it and hold it open.

Prevention

Taking action to control your risk factors can help prevent or delay carotid artery disease and stroke. Your risk for carotid artery disease increases with the number of risk factors you have.

ONE STEP YOU CAN TAKE IS TO ADOPT A HEART-HEALTHY LIFESTYLE, WHICH CAN INCLUDE:

Heart-Healthy Eating. Following heart-healthy eating is an important part of a healthy lifestyle.

Maintaining a Healthy Weight. If you’re overweight or obese, work with your doctor to create a reasonable plan for weight loss. Controlling your weight helps you control risk factors for carotid artery disease.

Physical Activity. Be as physically active as you can. Physical activity can improve your fitness level and your health.

Quit Smoking. If you smoke, quit.

Other steps that can prevent or delay carotid artery disease include knowing your family history of carotid artery disease. If you or someone in your family has carotid artery disease, be sure to tell your doctor.

If lifestyle changes aren’t enough, your doctor may prescribe medicines to control your carotid artery disease risk factors.

Risk Factors

The major risk factors for carotid artery disease, listed below, also are the major risk factors for coronary artery disease and peripheral arterial disease.

• Diabetes. People who have diabetes are four times more likely to have carotid artery disease than are people who don’t have diabetes.
• Family history of atherosclerosis. People who have a family history of atherosclerosis are more likely to develop carotid artery disease.
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. High blood pressure
• Lack of physical activity. Too much sitting and a lack of aerobic activity can worsen other risk factors for carotid artery disease, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
• Metabolic Syndrome. Metabolic syndrome is the name for a group of risk factors that raise your risk for stroke and other health problems, such as diabetes and heart disease.
• Older age. As you age, your risk for atherosclerosis increases. The process of atherosclerosis begins in youth and typically progresses over many decades before diseases develop.
• Overweight or obesity.
• Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure.
• Unhealthy blood cholesterol levels. This includes high LDL (“bad”) cholesterol) and low HDL (“good”) cholesterol.
• Unhealthy diet. An unhealthy diet can raise your risk for carotid artery disease. Foods that are high in saturated and trans fats, cholesterol, sodium, and sugar can worsen other risk factors for carotid artery disease.

Having any of these risk factors does not guarantee that you’ll develop carotid artery disease. However, if you know that you have one or more risk factors, you can take steps to help prevent or delay the disease.

If you have plaque buildup in your carotid arteries, you also may have plaque buildup in other arteries. People who have carotid artery disease also are at increased risk for coronary heart disease.

Causes

Carotid artery disease seems to start when damage occurs to the inner layers of the carotid arteries.

MAJOR FACTORS THAT CONTRIBUTE TO DAMAGE INCLUDE:

• Smoking
• High levels of certain fats and cholesterol in the blood
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

The plaque in an artery can crack or rupture. If this happens, blood cell fragments called platelets will stick to the site of the injury and may clump together to form blood clots.

The buildup of plaque or blood clots can severely narrow or block the carotid arteries. This limits the flow of oxygen-rich blood to your brain, which can cause a stroke.

Symptoms

Carotid artery disease may not cause signs or symptoms until it severely narrows or blocks a carotid artery. Signs and symptoms may include a bruit, a transient ischemic attack, or a stroke.

During a physical exam, your doctor may listen to your carotid arteries with a stethoscope. He or she may hear a whooshing sound called a bruit. This sound may suggest changed or reduced blood flow due to plaque buildup.

For some people, having a transient ischemic attack or “mini-stroke,” is the first sign of carotid artery disease. During a mini-stroke, you may have some or all of the symptoms of a stroke. However, the symptoms usually go away on their own within 24 hours.

Stroke and mini-stroke symptoms may include:

• A sudden, severe headache with no known cause
• Dizziness or loss of balance
• Inability to move one or more of your limbs
• Sudden trouble seeing in one or both eyes
• Sudden weakness or numbness in the face or limbs, often on just one side of the body
• Trouble speaking or understanding speech

Even if the symptoms stop quickly, call 9–1–1 for emergency help.

A mini-stroke is a warning sign that you’re at high risk of having a stroke.

The symptoms of a stroke are the same as those of a mini-stroke, but the results are not. A stroke can cause lasting brain damage; long-term disability, such as vision or speech problems or paralysis (an inability to move); or death. Most people who have strokes have not previously had warning mini-strokes.

Getting treatment for a stroke right away is very important. 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.

Call 9–1–1 for emergency help as soon as symptoms occur.

Diagnosis

Your doctor will diagnose carotid artery disease based on your medical history, a physical exam, and test results.

Your doctor will find out whether you have any of the major risk factors for carotid artery disease. He or she also will ask whether you’ve had any signs or symptoms of a mini-stroke or stroke.

To check your carotid arteries, your doctor will listen to them with a stethoscope. He or she will listen for a whooshing sound called a bruit. This sound may indicate changed or reduced blood flow due to plaque buildup. To find out more, your doctor may recommend tests.

Treatment

Treatments for carotid artery disease may include healthy lifestyle changes, medicines, and medical procedures.

Your doctor may recommend heart-healthy lifestyle changes if you have carotid artery disease. Heart-healthy lifestyle changes include:

• Heart-healthy eating
• Maintaining a healthy weight
• Managing stress
• Physical activity
• Quitting smoking

YOUR DOCTOR MAY RECOMMEND A HEART-HEALTHY EATING PLAN, WHICH SHOULD INCLUDE:

• Fat-free or low-fat dairy products
• Fish high in omega-3 fatty acids
• Fruits
• Legumes
• Vegetables
• Whole grains

Try to limit alcohol intake. Too much alcohol can raise your blood pressure and triglyceride levels, a type of fat found in the blood.

Maintaining a healthy weight is important for overall health and can lower your risk for carotid artery disease.

Routine physical activity can lower many risk factors for coronary heart disease, including LDL (“bad”) cholesterol, high blood pressure, and excess weight. Physical activity also can lower your risk for diabetes and raise your HDL (“good”) cholesterol level.

Talk with your doctor before you start a new exercise plan. Ask your doctor how much and what kinds of physical activity are safe for you.

If you smoke, quit. Smoking can raise your risk for coronary heart disease and heart attack and worsen other coronary heart disease risk factors.

If you have a stroke caused by a blood clot, you may be given a clot-dissolving, or clot-busting, medication. This type of medication must be given within 4 hours of symptom onset. The sooner treatment occurs, the better your chances of recovery. If you think you’re having a stroke, call 9–1–1 right away for emergency care.

Medicines to prevent blood clots are the mainstay treatment for people who have carotid artery disease. They prevent platelets from clumping together and forming blood clots in your carotid arteries, which can lead to a stroke.

Sometimes lifestyle changes alone aren’t enough to control your cholesterol levels.You may need a medical procedure if you have symptoms caused by the narrowing of the carotid artery.

Recovery

If you have carotid artery disease, you can take steps to manage the condition, reduce risk factors, and prevent complications. These steps include making lifestyle changes, following your treatment plan, and getting ongoing care.

Having carotid artery disease raises your risk of having a stroke. Know the warning signs of a stroke—such as weakness and trouble speaking—and what to do if they occur. Call 9–1–1 as soon as symptoms start (do not drive yourself to the hospital).