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What Is Carotid Artery Stenosis Or Carotid Artery Disease ?

Carotid artery stenosis is the narrowing of the carotid arteries. These are the main arteries in the neck that supply blood to the brain. Carotid artery stenosis, also called carotid artery disease, is a major risk factor for ischemic stroke. (This is the most common form of stroke and is usually caused by a blood clot plugging an artery.)

The narrowing is usually caused by plaque in a blood vessel. Plaque forms when cholesterol, fat and other substances build up in the inner lining of an artery. This process is called atherosclerosis.

What Is Stroke ?

A stroke, or brain attack, occurs when an occlusion in the blood supply to the brain occurs, as a result of a clot or the rupture of a blood vessel in the brain. Because blood flow is interrupted, ischemia will cause the destruction of brain cells in the surrounding area within a few minutes, and once brain cells are destroyed, they cannot be revived. Activities of the body that are controlled within those areas of the brain that are destroyed, such as movement, speech, and vision, are impaired or lost. The extent to which these activities are impaired or lost depends on both the size and the area in the brain where the stroke occurs.

How Is Carotid Artery Stenosis Treated ?

Depending on the degree of stenosis and the patient's overall condition, carotid artery stenosis can usually be treated with surgery. The procedure is called carotid endarterectomy. It removes the plaque that caused the carotid artery to narrow. Carotid endarterectomy has proven to benefit patients with arteries stenosed (narrowed) by 70 percent or more. For people with arteries narrowed less than 50 percent, anti-clotting medicine is usually prescribed to reduce the risk of ischemic stroke. Examples of these drugs are antiplatelet agents and anticoagulants.
Carotid angioplasty may be another treatment option. It uses balloons and/or stents to open a narrowed artery. 

How Does Carotid Artery Disease Happen ?

Like the arteries that supply blood to the heart -- the coronary arteries -- the carotid arteries can also develop atherosclerosis or “hardening of the arteries” on the inside of the vessels.
Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke. 

A stroke -- sometimes called a “brain attack” -- is similar to a heart attack. It occurs when blood flow is cut off from part of the brain. If the lack of blood flow lasts for more than 3 to 6 hours, the damage is usually permanent.

A stroke can occur if:

  • The Artery Becomes Extremely Narrowed
  • There’s A Rupture In An Artery To The Brain That Has Atherosclerosis
  • A Piece Of Plaque Breaks Off And Travels To The Smaller Arteries Of The Brain
  • A Blood Clot Forms And Obstructs A Blood Vessel

Strokes can occur as a result of other conditions besides carotid artery disease. For example, sudden bleeding in the brain, called intracerebral hemorrhage, can cause a stroke.

Other possible causes include:

  • Sudden Bleeding In The Spinal Fluid Space -- Subarachnoid Hemorrhage
  • Atrial Fibrillation
  • Cardiomyopathy
  • Blockage Of Tiny Arteries Inside The Brain

What Are the Risk Factors for Carotid Artery Disease ?

The risk factors for carotid artery disease are similar to those for other types of heart disease. They include:

  • Age
  • Smoking
  • Hypertension (High Blood Pressure) -- The Most Important Treatable Risk Factor For Stroke
  • Abnormal Lipids Or High Cholesterol
  • Diet High In Saturated Fats
  • Insulin Resistance
  • Diabetes
  • Obesity
  • Sedentary Lifestyle
  • Family History Of Atherosclerosis, Either Coronary Artery Disease Or Carotid Artery Disease

What Is The Treatment ?

The treatment for carotid artery stenosis depends upon the degree of blockage and the presence of symptoms. If the carotid artery is less than 70% blocked and you have no symptoms, doctors usually recommend aspirin treatment. One aspirin per day will reduce the likelihood of a blood clot and decrease your chance of stroke. Your treatment will include regular checkups with your doctor to see if your condition changes. If the carotid artery is less than 70% blocked, but you have symptoms, the treatment depends upon the results of the cerebral arteriogram. If this test shows no other problems, patients are usually started on daily aspirin treatment. Again, treatment will include regular checkups for any changes in your condition.

However, if the plaque looks rough and irregular, your doctor may recommend surgery to remove the plaque. If the carotid artery is more than a 70% blocked and you have symptoms, the usual treatment is surgery. This procedure, called carotid endarterectomy, involves removing the plaque from the carotid artery. You are placed under general anesthesia and the surgeon makes a small cut (incision) in your neck to expose the artery. He or she then makes a cut in the artery and removes the blockage. The artery is repaired and the incision in your neck is closed with stitches. Following the surgery, you may need to take medicine that makes your blood less likely to clot. There is a one to two percent risk of stroke with this procedure.

Another promising procedure is called carotid angioplasty. With this procedure, the area around the carotid artery is numbed with a local anesthetic. Then, a long, thin tube, called a catheter, is passed into the carotid artery in the area of the blockage. The catheter has a balloon on its tip. When the balloon is inflated, it stretches and opens the blocked artery.

Self-Care Tips

You can help prevent carotid artery stenosis and stroke by following recommendations for preventing atherosclerosis. This means following a diet that is low in fat and cholesterol, exercising regularly, maintaining a healthy weight, and avoiding cigarette smoking.

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