Canada Vascular

Cerebrovascular Disease

Background

How Can Carotid Artery Disease Be Diagnosed?

Treatment Options

How Can I Get Screened & Treated for Cerebrovascular Disease?

Common Questions & Answers

Bibliography

 

 


Background

What is Carotid Artery & Cerebrovascular Disease?

What are the Symptoms?

What Causes Carotid Artery & Cerebrovascular Disease?

 

What is Carotid Artery Disease?

Carotid artery disease occurs when the major arteries in your neck become narrowed or blocked. These arteries, called the carotid arteries, supply your brain with blood. Your carotid arteries extend from your aorta in your chest to the brain inside your skull.

You are more likely to develop carotid artery disease as you age. Only 1 percent of adults age 50 to 59 have significantly narrowed carotid arteries, but 10 percent of adults age 80 to 89 have this problem.

Your arteries are normally smooth and unobstructed on the inside, but as you age, a sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, when enough plaque builds up to reduce or disturb blood flow through your carotid arteries, physicians call this problem carotid artery disease. Carotid artery disease is a serious health problem because it can cause a stroke.

Some plaque deposits are soft and are prone to cracking or forming roughened, irregular areas inside the artery. If this happens, your body will respond as if you were injured and flood the cracked and irregular area with blood-clotting cells called platelets. A large blood clot may then form in your carotid artery or one of its branches. If the clot blocks the artery enough to slow or stop blood and oxygen flow to your brain, it could cause a stroke. More commonly, a piece of the plaque itself, or a clot, breaks off from the plaque deposit and travels through your bloodstream. This particle can then lodge in a smaller artery in your brain and cause a stroke by blocking the artery.

Fortunately, you may be able to prevent or slow carotid artery disease. Quitting smoking is the most important change you can make to avoid this disease. Other ways to prevent carotid artery disease include:

  • Exercising regularly
  • Eating a healthy diet
  • Maintaining a healthy weight

Controlling factors that increase your chances of developing carotid artery disease, such as diabetes, high blood pressure, or high cholesterol, also help prevent the disease.

 

What Are the Symptoms?

Carotid artery disease may not cause symptoms in its early stages.

Unfortunately, the first sign of carotid artery disease could be a stroke. However, you may experience warning symptoms of a stroke called transient ischemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and include:

  • Feeling weakness, numbness, or a tingling sensation on one side of your body, for example, in an arm or a leg
  • Being unable to control the movement of an arm or a leg
  • Losing vision in one eye (many people describe this sensation as a window shade coming down)
  • Being unable to speak clearly

These symptoms usually go away completely within 24 hours. However, you should not ignore them. Having a TIA means that you are at serious risk of a stroke in the near future. You should report TIA symptoms to your physician immediately.

If you experience the above symptoms for longer than a few hours, or they don't resolve within 24 hours, a stroke has probably occurred. You should contact your physician immediately.

 

What Causes Cerebrovascular & Carotid Artery Disease?

Hardening of the arteries causes most cases of carotid artery disease.

Experts do not fully understand the cause of hardening of the arteries. Plaque may build up in the arteries because of an injury to the artery's inner lining. Factors that injure artery walls include smoking, high cholesterol, and high blood pressure.

In rare cases, conditions known as carotid aneurysm disease and fibromuscular dysplasia can cause carotid artery disease.

Other factors that may increase your chances of developing carotid artery disease include diabetes and having a family history of hardening of the arteries.

 

Carotid Stent Case

Dr. S. Kundu BSc, MD, FRCPC, DABR, FASA
Dr. J.M. You MD, FRCPS

Clinical History

64 years old male presented with a 6 month history of intermittent difficulty with speech, and transient numbness every three to four days and transient numbness in right hand. Carotid Ultrasound, echocardiogram, ECG and bloodwork were all negative. Patient referred to speech pathologist and a psychiatrist. After three months patient referred to a Neurologist and a Computed Tomography Angiogram was performed.

Clinical Investigation

Computed Tomography Angiogram demonstrated a severe eccentric Left Common Carotid Stennosis (Fig 1 & 2). Patient was referred for Carotid Stenting as surgery was determined to be a difficult option given the proximal location of the stennosis.

Fig. 1 Fig. 2

Materials and Methods

A Thoracic Aortogram demonstrated the origin of the great arch vessels to be within normal limits. There was a moderate to severe narrowing of the proximal Left Common Carotid Artery (Fig 3). A left cerebral angiogram was within normal limits Cannulation past the stennosis was performed with a .035 Cook Roas Runner Hydrophilic Wire, 5 French Cook DAV 100 cm catheter, and a 5 French Cook Shuttle Sheath. A 6 mm Angioguard Cordis Distal Protection Device was inserted in the proximal left internal carotid artery. A 7 x 40 mm Cordis Precise Stent was inserted at the site of the stennosis (Fig 4). A post stent placement balloon dilation was performed with a Cordis 6 x 20 mm Ameia balloon. Post balloon dilation, the left common carotid artery appeared widely patent (Fig 5 & 6). A left cerebral angiogram was within normal limits. Case performed at Scarborough General Hospital: General Campus.

Clinical Outcome

There was a complete resolution of the patient's symptoms with no further episodes of speech difficulty or numbness.

Summary

Carotid stenting is a viable treatment alternative to carotid endarterectomy in patients with proximal common carotid artery lesions, operative risk factors, post-operative restennosis, and high internal carotid artery lesions.

Fig. 3 Fig. 4 Fig. 5
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