Carotid Disease

About

  • Carotid stenosis, also known as cerebrovascular disease or carotid disease, is chronic narrowing of the arteries that supply the brain (the internal carotid arteries), due to build-up of plaque (known as atherosclerosis).

    This often causes no symptoms, but can cause strokes (cerebrovascular accidents), or a transient ischemic attack (a TIA, or a stroke who’s symptoms last less than 24 hours).

  • 3% of the population have narrowing of the internal carotid artery.

  • Risk factors for carotid stenosis include:

    • Smoking

    • Diabetes

    • Hypertension (high blood pressure)

    • Hypercholesterolemia (high cholesterol)

    • Age

    • Being male

    • Family history of stroke

    • Kidney disease

  • Carotid stenosis results from plaque formation (called atherosclerosis) in the carotid arteries that supply the brain.

    Atherosclerosis occurs due to damage of the innermost layer of the artery. This damaged inner layer then allows inflammatory and cholesterol-carrying cells to get under this layer, causing narrowing or blockage of the artery.

    Often this does not cause any problems. However, in some patients, small amounts of plaque or thrombus (clot) can break off from the carotid plaque, and move to the brain. This blocks off the blood supply to that area of the brain, and causes a stroke or TIA.

  • Carotid stenosis usually causes no symptoms.

    If symptoms occur, they are the result of a stroke or TIA. These symptoms can include:

    • Weakness of arms or legs

    • Loss of sensation of arms or legs

    • Inability to speak, or not making sense when speaking

    • Loss of vision in one eye

  • Assessment begins with a thorough discussion about your medical history, followed by clinical examination.

    An ultrasound called an arterial duplex often follows, which is an excellent tool for imaging arteries of the neck.

    A CT scan with intravenous contrast is occasionally required.

TREATMENT

How do you treat carotid stenosis?

There are several treatment options for carotid stenosis, depending on the site of the narrowing/blockage, and the symptoms.

Most people do not need any surgical intervention for their carotid stenosis, and instead it can be managed with medication.

However, if there is narrowing of the carotids of over 80%, and after repeat scanning this is getting worse despite being on the right medications, you may need an operation.

If you have had a stroke or TIA, you may need one of the operations listed below.

Treatment options include:

  • Conservative measures – managing your risk factors (like blood pressure), in addition to blood thinners like aspirin, and a cholesterol-lowering medication like a statin, will greatly reduce your risk of a stroke.

  • Carotid endarterectomy – this is open surgery, where an incision is made in the neck, and the carotid artery is opened and the plaque removed. A new roof called a ‘patch’ is sewn into the incision in the artery, to make sure the artery remains open.

  • Carotid stenting – also called ‘keyhole surgery’, this involves a small incision in the groin or wrist, and after a wire is passed across the narrowing in the carotid artery, a stent (a tubular metal frame) is used to keep the artery open. This is usually only performed if open surgery is not appropriate.

We will discuss which treatment option may be most suitable for you, with consideration of your preferences and factors such as:

  • The severity of your symptoms

  • Which arteries are affected

  • Your medical history

What are the risk of surgery?

Any operation requiring a general anaesthetic has risks like stroke, heart attacks, respiratory failure, or death. As such, we avoid general anaesthetics in people who are at high risk of these complications.

The main risks of interventions for carotid stenosis are listed below. These are often prevented by careful planning and treatment. While these can be life-threatening, they are actively watched for, and if they occur are immediately managed.

Risks of carotid endarterectomy:

  • Stroke

  • Bleeding or bruising

  • Nerve injury

  • Infection

  • Slow-healing wounds

Risks of carotid stenting:

  • Stroke

  • Bleeding or bruising

  • Reduction of blood supply to the arms or legs

  • Infection

  • Kidney damage

Do I need to follow-up with my Vascular Surgeon after the operation?

Dr Shiraev will want to see you after your operation, to make sure you have recovered well, your wounds are healing, and answer any questions you may have.

Rarely does carotid narrowing re-occur, however people with carotid stenosis often benefit from monitoring, which may involve an annual checkup and ultrasound.

This advice is general, and is not intended to replace a formal clinical assessment and discussion with a health professional.