With the aging of the general population and the availability of noninvasive imaging studies, carotid artery stenosis is a disease commonly seen in general medical practice. Differentiation between symptomatic and asymptomatic disease is critical to the treatment course because the natural history differs markedly between them. Antiplatelet therapy and aggressive treatment of vascular risk factors are the mainstays of medical therapy.
Class I evidence shows that carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events in patients with symptomatic moderate- and high-grade stenosis. The procedure is also effective in selected patients with asymptomatic stenosis, but the benefit is marginal. In the past decade, carotid angioplasty and stenting has been proposed as a valid alternative to CEA. Currently, it is unclear whether carotid angioplasty and stenting is as safe as CEA in patients with carotid artery stenosis who need invasive treatment.
You may not have any symptoms of carotid artery disease. Plaque builds up in the carotid arteries over time with no warning signs until you have a transient ischemic attack(TIA) or a stroke.
Signs of a stroke may include:
- Sudden loss of vision, blurred vision, or difficulty in seeing out of one or both eyes
- Weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg
- Sudden difficulty in walking, loss of balance, lack of coordination
- Sudden dizziness and/or confusion
- Difficulty speaking (called aphasia)
- Sudden severe headache
- Problems with memory
- Difficulty swallowing (called dysphagia)
The risk factors for carotid artery disease are similar to those for other types of heart disease.
- Hypertension (high blood pressure) -- the most important treatable risk factor for stroke
- Abnormal lipids or high cholesterol
- Insulin resistance
- Sedentary lifestyle
- Family history of atherosclerosis, either coronary artery disease or carotid artery disease
There are often no symptoms of carotid artery disease until you have a TIA or stroke. That’s why it’s important to see your doctor regularly for physical exams. Your doctor may listen to the arteries in your neck with a stethoscope. If an abnormal sound, called a bruit, is heard over an artery, it may reflect turbulent blood flow. That could indicate carotid artery disease.
Listening for a bruit in the neck is a simple, safe, and inexpensive way to screen for stenosis (narrowing) of the carotid artery, although it may not detect all blockages. Some experts believe that bruits may be better predictors of atherosclerotic disease rather than risk of stroke. Be sure to let your doctor know if you have had any symptoms, such as those listed above.
- Carotid ultrasound (standard or Doppler).
- Magnetic resonance angiography (MRA).
- Computerized tomography angiography (CTA).
- Cerebral angiography (carotid angiogram).
To effectively treat carotid artery disease, doctors recommend the following:
Following recommended lifestyle habits.
- Taking medications as prescribed.
- Considering a procedure to improve blood flow, if your doctor believes it could help reduce your risk of future stroke.
To keep carotid artery disease from progressing, the following lifestyle changes are recommended:
- Quit smoking.
- Control high blood pressure.
- Control diabetes.
- Have regular checkups with your doctor.
- Have your doctor check your cholesterol and get treatment, if necessary.
- Eat a heart-healthy diet.
- Maintain a healthy weight.
- Exercise at least 30 minutes most days of the week.
- Limit alcohol to 1 drink per day for women, 2 for men.
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