Carotid Artery Disease and Stroke Prevention

Carotid Artery Disease and Stroke Prevention

Carotid Artery Disease1

The carotid arteries are two main arteries that carry blood from the heart, up through the neck, to the brain. Healthy carotid arteries are smooth and unobstructed, allowing blood to flow freely to the brain and provide oxygen, glucose, and other nutrients.

Over time, carotid arteries can build up plaque, which is mostly made of fat and cholesterol. This plaque narrows the insides of the arteries and makes them stiff in a process commonly referred to as "hardening of the arteries," or atherosclerosis.

Carotid artery disease results when the carotid arteries have become narrow or obstructed, creating a risk of plaque traveling to the brain, where it can cause a stroke.

what is carotid artery disease?

Carotid Artery Disease and Stroke Risk

Carotid artery disease increases stroke in 3 ways2

  • Plaque can severly narrow the carotid artery and restrict blood flow
  • Plaque can break off from within the carotid artery and block smaller arteries in the brain
  • Blood clots can become wedged in a carotid artery stenosis

In 2020, the following estimates were made:3

Stroke is the fifth leading cause of death globally

stroke is 5th leading cause of death globally

Someone dies from a stroke every 3 minutes

someone dies from a stroke every 3 minutes

Stroke deaths have increased by 24% from 2010 to 2020

stroke deaths have increased 24%

Stroke accounted for 1 of every 21 deaths in the United States

stroke accounted for 1 of every 21 deaths in the US

Symptoms of a Stroke in Men and Women4

Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body

Sudden numbness or weakness

Sudden confusion, trouble speaking, or difficulty understanding speech

Sudden confusion or trouble speaking

Sudden trouble seeing in one or both eyes

Trouble seeing

Sudden trouble walking, dizziness, loss of balance, or lack of coordination

Sudden trouble walking or dizziness

Sudden severe headache with no known cause

Sudden severe headache
symptoms of stroke
symptoms of stroke

Carotid Artery Disease Risk Factors5

There are several factors that can increase the chance of developing this condition over time

  • High Blood Pressure
  • Tobacco Use
  • Diabetes
  • High blood fat levels
  • Family History
  • Age
  • Obesity
Carotid artery disease risk factors

Diagnosing Carotid Artery Disease

There are several tests used to diagnose carotid artery disease and learn more about the size and location of the blockage, including:6

Ultrasound

Also called a duplex ultrasound, this type of test uses sound waves to view how blood is flowing through the arteries and locate areas where they may be blocked or narrowed.

Ultrasound

Cerebral Angiography

 A minmally invasive procedure that uses a catheter and contrast material to view inside the arteries and get a close look at the blockage.

Cerebral Angiography

Computed Tomography Angiography (CTA)

This test uses injectable dye and a CT scanner to created detailed images of the arteries. It may be used on patients with pacemakers or stents from other conditions.

Computed Tomography Angiography

Magnetic Resonance Angiography (MRA)

Similar to a CT scan but without using X-rays, this noninvasive test provides detailed images of the arteries.

Magnetic Resonance Angiography

Treatment Options

The main goal of treatment is to halt the progression of the disease. Additional therapies may be considered in more severe cases, such as those causing symptoms of TIA or a stroke.7

Optimal Medical Therapy (OMT)

This treatment combines lifestyle modifications such as diet, exercise, and smoking cessation, with pharmacological therapy, including antiplatelets, lipid-lowering agents, blood pressure reduction, and glycemic control.8

Optimal medical therapy

Transfemoral Carotid Artery Stenting (TFCAS)

A surgeon or interventionalist sends a catheter to the narrowed carotid artery in the neck, then places a stent into the vessel to keep the artery from narrowing again.9

Transfemoral Carotid Artery Stenting (TFCAS)

Carotid Endarterectomy (CEA)

A surgeon makes in incision along the front of the neck, opens the carotid artery and removes the plaque, then closes the artery with stitches or a patch made with a vein or artificial materials.9

Carotid Endarterectomy

Transcarotid Artery Revascularization (TCAR)

A minimally invasive procedure that can clear blockages and open a narrowed carotid artery. During the TCAR procedure, the surgical team reverses blood flow in the area of the blockage, decreasing the risk of stroke as a surgical balloon and stents are used to reopen the narrowed artery.10

Transcarotid Artery Revascularization

Information and Resources

The Centers for Medicare and Medicaid Services (CMS) has expanded coverage for Carotid Artery Stenting (CAS) procedures to patients for the treatment of carotid artery stenosis in NCD 20.7

More information is available at Abbott Medicare and Medicaid Resources

more information

References

  1. SVS (n.d.). Carotid Artery Disease Your Vascular Health, https://vascular.org.
  2. The Texas Heart Institute (2024). Carotid Artery Disease. https://www.texasheart.org
  3. Tsao, C., et al. (2023) Heart Disease and Stroke Statistics—2023 Update: A Report from the AHA. Circulation. https://doi.org/10.1161/CIR.0000000000001123
  4. CDC (2024). Sign and Symptoms of Stroke. https://www.cdc.gov/stroke.
  5. Mayo Clinic (2024). Carotid Artery Disease. https://www.mayoclinic.org.
  6. Cleveland Clinic (2024). Carotid Artery Disease. https://my.clevelandclinic.org.
  7. Elsayed et al. (2021). Outcomes of carotid revascularization in the treatment of restenosis after prior carotid endarterectomy. Stroke. https://doi.org/10.1161/STROKEAHA.120.033667
  8. Hackman (2021). Optimal Medical Management of Asymptomatic Carotid Stenosis, AHA/ASA Journal. https://doi.org/10.1161/STROKEAHA.120.033994
  9. Mayo Clinic (2024). Carotid Endarterectomy. https://www.mayoclinic.org
  10. Penn Medicine (2024). Transcarotid Artery Revascularization (TCAR), https://www.pennmedicine.org

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