Carotid Artery Disease

Each of us has large arteries in our neck that carry blood to our brain. Known as carotid arteries, these major blood vessels begin at the top of your heart and end in your brain.

If you have carotid artery disease, also known as carotid artery stenosis, it means one or more of your carotid arteries has become narrowed or even blocked thanks to a build-up of a sticky substance called plaque. As plaque continues to coat the walls of your carotid arteries, it may reduce or stop blood from reaching your brain and ultimately cause a stroke.

While carotid artery disease is usually caused by a build-up of plaque on the artery walls, there are several other disorders that can affect your carotid artery. Vascular surgeons at Scripps treat the following conditions:

• Carotid artery occlusion (carotid artery blockage), which occurs when the carotid artery becomes completely blocked and deprives the brain of oxygen.
• Carotid dissection, or a tear in one of the three layers of tissue that make up the carotid artery wall. When this occurs, blood begins to leak into the remaining layers and can cause a clot that reduces or blocks blood flow.
• Carotid body tumors, also called chemodectomas or paragangliomas, are tumors that develop in the neck where the carotid artery branches and can present with a painless mass on the neck. About 5-10% of these tumors are malignant and they can grow large if untreated. 
• Fibromuscular dysplasia, a rare condition caused by abnormal cell growth in an artery wall. While fibromuscular dysplasia can occur anywhere in the body, it often presents in the carotid artery and can lead to narrowing, bulging or tearing that eventually reduces or blocks blood flow to the brain.

Carotid artery disease may occur without any symptoms. In fact, many people don’t realize they have carotid artery disease until it is already advanced, and causes either a stroke, or a “mini stroke” called a transient ischemic attack.

If you experience any stroke warning signs — including temporary loss of vision in one eye, weakness or numbness on one side of your body, or trouble speaking — you should call your doctor or 911 immediately, because you may be at serious risk for a stroke in the near future.

Risk factors for carotid artery disease include:

• A family history of high blood pressure or hardened arteries (also known as atherosclerosis)
• High cholesterol
• Smoking
• Obesity
• Diabetes

Risk increases with age for both men and women, although women over 75 are at a greater risk than men.

Scripps physicians can diagnose carotid artery disease using one or more of the following tests:

• Carotid ultrasound, also known as carotid duplex ultrasound, is a painless test performed with a small ultrasound probe, placed at the neck, which can detect how quickly blood is flowing through the carotid arteries. While a carotid ultrasound can detect many cases of carotid artery disease, it is often performed in combination with some of the tests below to more precisely assess what is happening within the arteries.
• Computed tomography (CT) scan, a painless, noninvasive way to see inside the body using X-ray imaging
• Magnetic resonance imaging (MRI) scan, a procedure that uses a powerful magnet, radio waves and computer technology to produce pictures without using ionizing radiation
• Computed tomography angiography (CTA), a procedure where contrast dye is placed intravenously (IV) and then used by the CT scanner to create the images of blood vessels
• Magnetic resonance angiography (MRA), a type of MRI that is used to look at blood vessels and the way blood is flowing through them
• Conventional angiography, which is an imaging test that uses X-rays and a special dye to see inside the arteries.

If you’ve been diagnosed with carotid artery disease, your Scripps vascular surgeon will create a treatment plan for you based on several factors, including the severity of your condition, whether or not you’re experiencing symptoms, and your overall health.

In addition to prescribing medication and lifestyle changes, your doctor may recommend one of the following procedures:

• Carotid endarterectomy, a surgical procedure in which plaque is removed from the carotid artery so it is no longer narrowed or blocked
• Transcarotid artery revascularization (TCAR), essentially carotid angioplasty and stenting, an endovascular procedure that uses a balloon-tipped catheter to first flatten the plaque and inflate the artery, then insert a tiny device called a stent that keeps the artery propped open. This procedure is performed with reversal of flow across the treated area in an effort to flush the plaque and filter the blood, preventing debris from reaching the sensitive brain. This is accomplished by filtering the blood during the procedure and returning it via a catheter in the femoral vein.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion
• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego