CAROTID ARTERY DISEASE

The Carotid arteries are the two main blood vessels on the right and left front of the neck, carrying oxygenated blood to the brain.
Sometimes these arteries are involved in arteriosclerosis, which is the hardening and loss of elasticity of the wall of the artery when it becomes clogged with fatty deposits. Plaque builds up on the inside wall of the artery; can cause restricted blood flow to the brain, or a fragment of the plaque to break off and travel in the blood flow to the brain. Severe blockage of blood flow to the brain can cause a stroke.

At least 3 in 4 persons who suffer a stroke related to Carotid Artery Disease get a warning before the stroke (TIA- transient ischaemic attack). This attack is temporary and can last less than 24 hours and the patient completely recovers. The attack can cause symptoms such as:

· Weakness, numbness or tingling on one side of the body. (arm and leg)
· Difficulty in speaking (slurred speech)
· Loss of vision in one eye (fleeting blindness)
· Memory loss.

What causes Carotid Artery Disease?

There is no single cause for carotid artery disease, but several factors may predispose someone to the disease.

These contributing factors include:

· Family history
· High blood cholesterol
· Smoking
· Raised blood pressure
· Diabetes mellitus

Types of Carotid Artery Disease

Asymptomatic carotid artery disease

In recent studies it has been shown that not every patient with carotid artery stenosis (narrowing) suffers any symptoms. If carotid artery disease does not cause any symptoms before it is diagnosed, it is called asymtomatic. Restricted blood flow through a narrowing in the carotid artery may cause a noise (bruit) that can be heard when a stethoscope is placed on the site. However it is prudent that your doctor assesses your condition thoroughly.

In cases with less than 50% narrowing of the carotid artery, there is no proven benefit to undergo surgery, usually medical treatment is just as effective. Should the diameter of the carotid artery narrows to more than 50% then surgery for carotid endarterectomy (removal of the plaque causing the narrowing) is suggested.

Symptomatic carotid artery disease

The symptoms of carotid artery disease can occur alone or in combination such as numbness or weakness on one side of the body affecting the face, arm and leg; slurred speech (difficulty in forming words); blindness in the eye on the affected side and memory loss or loss of consciousness. It should be noted that, the right side of the brain controls by the left side of the body and vice versa. Therefore carotid artery disease on the right side of the neck will affect the left side of the body.
The symptoms associated with carotid artery disease may vary in length and can be temporary (lasting a few minutes) or permanent. If the symptoms clear within twenty- four hours and the patient completely recovers, it is called a TIA (transient ischaemic attack) or mini stroke as above.

Diagnostic tests

There are several ways in which the carotid arteries can be examined to determine whether there is narrowing.

Doppler ultrasound This test uses sound waves to check blood flow and measure the thickness of your carotid arteries. It is completely non-invasive, and is an excellent screening test to assess for narrowing of main arteries.

Magnetic Resonance Imaging (MRI), which is a type of magnetic resonance imaging that uses harmless but powerful magnetic fields to give a detailed picture of the arteries in your brain.

Arteriography which is the taking of X-ray pictures of the carotid artery after a special dye is injected into your bloodstream.

(Diagnostic tests: links & info taken from http://www.tmc.edu)

Treatment for Carotid Artery Disease
Carotid Endarterectomy
The most common treatment for carotid artery disease is carotid endarterectomy. During a carotid endarterectomy an incision is made along the front of the neck and the carotid artery is then opened and the atherosclerosis is removed. The artery is repaired with either sutures or a graft.

For some patients, direct surgical repair via a carotid endarterectomy is not a very good option. This may be because of the location of the stenosis (narrowing), or the patient's overall health may make surgery too risky.

Carotid Angioplasty
Carotid angioplasty and stenting, a relatively new procedure, shows promise in the treatment of carotid artery disease for patients who may not be in good enough health to undergo surgery — such as people with severe heart or lung disease, those who have had neck operations or radiation for neck tumours, and those who have already had carotid endarterectomies.

In carotid angioplasty, a balloon is attached to a catheter — a long tube — that is inserted in the groin artery and threaded through the arteries to the narrowed carotid artery. The balloon at the end of the catheter is inflated to open the narrowed area, and a metal stent, which is a kind of wire mesh tube, is left in place to keep the artery from narrowing again.

Patients are awake during the procedure, and are usually discharged from the hospital the following day. Most patients are able to resume normal activities when they get home.