Carotid Artery Disease

The narrowing of the carotid arteries is commonly related to atherosclerosis, a build-up of plaque in the inner lining of an artery. Because the carotid arteries deliver blood to the brain, carotid artery disease can have serious implications by reducing the flow of oxygen to the brain.

The brain needs a constant supply of oxygen in order to function. Brain cells begin to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of plaque breaks off and obstructs blood flow to the brain, a stroke may occur.

Signs of carotid artery disease

You may not experience any symptoms of carotid artery disease until significant plaque buildup obstructs blood flow to the brain or a piece of plaque breaks off and blocks blood to the brain. Depending on the severity of the blockage, you may have a transient ischemic attack (TIA) or a stroke.

A transient ischemic attack is a sudden or temporary loss of blood flow to an area of the brain, usually lasting a few minutes to one hour. Symptoms usually go away entirely within 24 hours. TIA is often a warning that you will have a major stroke. A stroke is a loss of blood flow to the brain that continues long enough to cause permanent brain damage.

Symptoms of a stroke or TIA may include:

• Sudden weakness or clumsiness of an arm and/or leg on one side of the body
• Sudden paralysis (inability to move) of an arm and/or leg on one side of the body
• Loss of coordination or movement
• Confusion, dizziness, fainting and/or headache
• Numbness or loss of sensation (feeling) in the face, arm and/or leg
• Temporary loss of vision or blurred vision
• Inability to speak clearly or slurred speech

If you experience any of these symptoms, call 911 immediately. 

Treatments for carotid artery disease

Carotid endarterectomy – In a carotid endarterectomy, plaque that has built up on the inside of the carotid artery wall is removed surgically. An incision is made on the side of the neck where the affected carotid artery is located. The artery is opened and the plaque removed. The artery is sutured back together, restoring normal blood flow to the brain. This has been the gold standard for treatment of carotid stenosis, but sometimes surgery is considered too high risk due to your other medical conditions and/or the anatomy of your carotid artery. But one of the two following procedure that may be available to you.

TCAR (or transcarotid arterial revascularization) –  With TCAR, a 1-2- centimeter incision is made above the collarbone to place a catheter into the carotid artery, which temporarily reverses the flow of blood away from the brain. Then a stent is placed to reopen the artery. Any bits of plaque dislodged during the procedure are safely sent into an external filter connected to the catheter. This significantly reduces the risk that plaque will travel to the brain and cause a stroke during surgery. The entire procedure usually takes about 60-90 minutes, can be done awake or with general anesthesia, and most patients go home the next day.

Transfemoral carotid artery angioplasty and stenting – is a minimally invasive procedure requiring only a small incision in the groin. A special long, hollow tube (catheter) is inserted into the carotid artery to be treated. This catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the carotid artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow. A tiny, expandable stent is inserted into the newly opened area of the artery to help keep the artery from narrowing or closing again.

This advanced minimally invasive technique is available for patients who have already had a stroke, are at high risk for stroke or are too fragile for surgery.

Because of the potential for clots to dislodge from the plaque into the circulation of the brain and possibly cause a stroke, an embolic protection device (EPD) is used during the procedure. It is a filter-like basket that is attached to the catheter and positioned in the artery to catch any clots or small debris that might break loose from the plaque during the procedure. This technique may help reduce the incidence of stroke during carotid artery angioplasty.

Carotid artery disease, also called carotid artery stenosis, occurs when the carotid arteries, the main blood vessels that carry oxygen-rich blood to the brain, become narrowed or blocked. If you need surgery to open the blockage, you’ll get the care you need at Lehigh Valley Health Network’s Heart and Vascular Center. Our vascular surgery program, the fifth-busiest in Pennsylvania, offers innovative procedures such as carotid artery angioplasty and stenting.

The narrowing of the carotid arteries is commonly related to atherosclerosis, a build-up of plaque in the inner lining of an artery. Because the carotid arteries deliver blood to the brain, carotid artery disease can have serious implications by reducing the flow of oxygen to the brain. The brain needs a constant supply of oxygen in order to function. Brain cells begin to die after just a few minutes without blood or oxygen. If the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of plaque breaks off and obstructs blood flow to the brain, a stroke may occur.