Risks associated with carotid artery disease and how to treat it

This content is sponsored by MedStar Washington Hospital Center.

Although the prevalence of carotid artery stenosis, or carotid artery disease, in the U.S. is low (3%), the outcome of not treating the disease can be life changing.

Carotid artery stenosis can increase a person’s risk of having a stroke. According to Dr. Krystal Maloni, a vascular surgeon at MedStar Washington Hospital Center, the disease is the most common, preventable cause of ischemic stroke.

Carotid artery stenosis happens when built-up plaque causes the narrowing of the blood vessels in the neck that carry blood from the heart to the brain.

Decreased blood flow traveling past the plaque to the brain or pieces of plaque breaking off and blocking smaller arteries can both cause strokes.

There could be no warning symptoms before carotid artery stenosis causes a stroke. However, in some instances, temporary warning symptoms like weakness, numbness, vision loss in one eye, and speech problems will occur.

Strokes can lead to irreversible damage, which is why medical professionals aggressively screen patients for carotid artery stenosis, Dr. Maloni said.

“Sometimes these are nonreversible things,” she said. “The brain doesn’t always recover, and the function doesn’t always recover, so we try to pretty aggressively seek these blockages out and avoid that.”

Risk factors for carotid artery stenosis include smoking, hypertension, advanced age and high cholesterol.

“Anybody who has a risk factor for having plaque anywhere is going to have risks for developing plaques in their carotid arteries,” Dr. Maloni said.

There are several methods a specialist can use if they suspect a patient has carotid artery stenosis.

One is a carotid ultrasound, which is a noninvasive test that uses sound waves to evaluate blood flow. Another method is an MRA of the neck, which uses a magnet to look at the neck arteries.An angiogram is a catheter-based procedure in which X-rays are taken while contrast dye is injected into the arteries. A CTA of the neck is a specific CT scan that evaluates arteries in the neck.

There are several treatments for carotid artery stenosis.

During a carotid endarterectomy, the artery is opened in the neck and the plaque is cleaned out. The surgery has been successful in lowering the risk of a stroke, and is considered the safest procedure for most patients.

Carotid artery stenting is an endovascular procedure in which a catheter is advanced through the carotid artery through the groin and a balloon is inflated to crack open the plaque. A metal stent is left in the artery to hold it open.

Dr. Maloni said more recently the transcarotid artery revascularization (TCAR) surgery has become more popular in treating the disease.

“It is very fast, it’s very well tolerated and patients do extremely well. It’s changed the way – and I think it’ll continue to change the way – we approach carotid disease.”

During the TCAR, the surgical team gains access to the common carotid artery and the common femoral artery and reverses the blood flow in the area of the blockage.

“So the blood is running from your carotid outside of your body through the filter back into your veins, so it’s auto transfusing,” Dr. Maloni explained. “So that reversal of flow allows for you to manipulate the carotid artery and any plaque or anything that is broken off comes through the filter.”

Surgeons then use a surgical balloon and stents to reopen the narrowed artery.

Dr. Maloni said the endarterectomy and the TCAR can produce similar results in reducing stroke risk, but the TCAR has fewer risks associated with it.

“With the TCAR, as compared to open endarterectomy, there’s shorter hospital stay and fewer cranial nerve injuries, which is one of the bigger complications related to endarterectomy. So TCAR is kind of the new kid on the block,” she said.

Patients must be at high risk to have the TCAR procedure covered by Medicare.

The biggest takeaway is that carotid artery stenosis is a preventable cause of stroke, Dr. Maloni said.

“We all use our bodies, but the way we use our brain, I think it’s different than the way we use any other organ. So anything that’s going to be impactful in preserving that function, I think, is of the utmost importance.”

Read more about carotid artery stenosis on the MedStar Washington Hospital Center’s website.

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