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Vascular Surgery - Carotid Artery Disease

Carotid arteries are the major arteries located in both sides of the neck and supply blood to most of the brain. Over time plaque can build up in the wall of these arteries causing them to harden and become narrow, this is know as carotid artery disease. The plaque may completely close off the artery or pieces of the plaque may break off and lodge in the brain, either process can cause a serious condition known as a stroke.

Risk factors:

 Family history, high blood pressure, high cholesterol, heart disease, diabetes, smoking, and obesity.

Symptoms:

Carotid artery disease may not cause symptoms. Unfortunately, the first sign of carotid artery disease could be a stroke or a "mini" stroke also known as a transient ischemic attack or TIA.

Symptoms of a TIA usually last a few minutes to 1 hour and include:

  • Feeling weak
  • numbness, or a tingling sensation on one side of your body
  • confusion
  • Being unable to control the movement of an arm or a leg
  • Losing vision in one eye (many people describe this sensation as a window shade coming down) 
  • Sudden drooping of one side of the face
  • Being unable to speak clearly
  • Sudden memory loss

Diagnosis and tests:

Blockage of the carotid arteries can occur without any signs or symptoms however it may lead to a stroke. Disease of the carotid arteries is often discovered during a routine examination, when a swishing sound is heard through a stethoscope placed on the neck.

If your doctor suspects carotid artery disease he or she will generally order a non invasive examination called a carotid artery duplex ultrasound. Additional tests you doctor may order to confirm the diagnosis include CAT scan, MRA, or cerebral angiogram

Prevention:

To keep carotid artery disease from progressing, doctors recommend eating a healthy diet, regular exercise, and lifestyle modifications

Lifestyle modifications include:

  • Quit smoking
  • Regular check ups
  • Control high blood pressure
  • Control diabetes. 
  • Limit alcohol intake

Treatment:

Mild blockage of the arteries is usually treated with medications however severe blockage is usually treated with surgery or a minimally invasive procedure known as a angioplasty and Stent.

Carotid endarterectomy (CEA ):  The patient is placed under general anesthesia. A 3-4 inch incision is made in the neck, the artery is isolated then the plaque is removed and the artery is sewn back together to allow improved blood flow to the brain. The risks and benefits depend on many factors such as age and other medical conditions that the patient may have. Typically the patient stays overnight in the intensive care unit and is discharged the next day.  

Carotid artery stenting (CAS): A small puncture is made in the groin then a specially designed wire and stent are placed in the diseased carotid artery. Once in place, the stent is expanded to hold the artery open. The patient feels little discomfort and is sent home the next day. This procedure is less invasive than carotid surgery, but is reserved for certain individuals.

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