Carotid Artery Disease and Stroke: What You Need to Know

Did you know that nearly 20% of all strokes are caused by a buildup of plaque in one of the main blood vessels in your neck, the carotid arteries? Since every 40 seconds someone in the U.S. suffers a stroke, it’s important to be aware of this potentially dangerous condition and understand your personal risk factors so you can take steps to prevent a stroke from happening to you.

Carotid artery disease and stroke

The carotid arteries are located on the side of your neck and deliver blood to the brain.

Carotid artery disease, also called carotid stenosis, occurs when fatty deposits clog the blood vessels that carry blood to your brain. A blockage increases your risk for stroke, a medical emergency that occurs when the blood supply to the brain is interrupted or seriously reduced.

“Most people don’t know they have carotid stenosis until it’s found on a physical exam by their primary care doctor or cardiologist. Typically, since there are no symptoms, patients don’t know they have the disease until they’ve had a stroke,” explains Mila Ju, MD, vascular and endovascular surgeon with LVPG Vascular Surgery.

That’s why if you have any risk factors for stroke, it’s important to have your health care provider perform regular screenings to make sure you do not have a carotid artery blockage that could cause a stroke.

Understanding your risk factors for stroke

Ju explains that most of the patients she sees are in their 60s and older. However, it’s not unusual to treat patients in their 40s and 50s, especially if they have more than one risk factor, including:

• Family history
• High cholesterol
• Smoking
• Unhealthy diet
• Sedentary lifestyle

Warning signs of stroke

Symptoms of stroke may be sudden and include:

• Weakness or numbness of the face, arm or leg, especially on one side of the body
• Confusion or difficulty speaking or understanding
• Problems with vision such as dimness or loss of vision in one or both eyes
• Dizziness or problems with balance or coordination
• Problems with movement or walking
• Severe headache with no known cause

“If you think you or someone else is having a stroke, time is of the essence. You should immediately call 911 – don’t waste time trying to get to the ER by car. You really need to act fast and get to an appropriate hospital as soon as possible,” Ju says.

Diagnosing and treating carotid artery disease

When a primary care physician or cardiologist suspects that a patient may have carotid stenosis, they will refer them to a vascular surgeon, who will typically perform an ultrasound. “If the imaging results confirm the diagnosis and the carotid artery is blocked by 70% or more, we will perform surgery to remove the blockage to prevent stroke,” Ju says.

“If they don’t qualify for surgery, we monitor patients to make sure stenosis doesn’t increase. We advise them on reducing their risk factors including quitting smoking and possibly putting them on proper cholesterol medication. We also counsel them on what stroke symptoms to watch out for and encourage them to eat better and exercise more.”

Surgical options

Lehigh Valley Health Network (LVHN) provides a comprehensive approach to treating carotid stenosis. “We offer both open surgical intervention and a minimally invasive approach for high-risk patients. Our neurology, cardiology and primary care teams work closely together to offer the best options for our patients,” Ju says. The most common surgery performed to remove plaque buildup in the carotid arteries is called carotid endarterectomy. This surgery is considered low risk and entails making an incision in the neck, clamping the artery, then removing the plaque. The artery is then closed, the clamp is released and blood flow is restored.

“This surgery has a very high success rate. Patients typically spend one night in the hospital and can return home the next day,” Ju says.

Certain high-risk patients do not qualify for carotid endarterectomy and instead require a minimally invasive procedure called trans carotid artery revascularization, or TCAR.

This procedure is performed through a small incision at the neckline just above the clavicle (collarbone). The surgeon places a tube directly into the carotid artery and connects it to a system that directs blood flow away from the brain, to prevent any loose plaque from reaching it. Filtered blood is then returned through a second tube in the upper leg. A carotid stent is then placed to stabilize the plaque in the carotid arteries. Finally, blood flow reversal is turned off and blood flow resumes in its normal direction.

LVHN’s collaborative team approach provides best options for treatment

Ju says that it’s important to use a team approach involving primary care physicians, cardiologists and neurologists to collaborate and offer the best options to treat patients with carotid stenosis and help prevent stroke.

“As a vascular surgeon at LVHN, I’m fortunate that I have many tools that I can offer my patients with carotid artery disease. I can offer open surgery or minimally invasive procedures, depending on their individual situation. I don’t see patients as one dimensional, I see them as a whole,” Ju says.

For more information on the treatment of carotid artery diseases at LVHN, visit LVHN.org/Stroke.