What is Carotid Disease?
4 arteries in the neck go up and supply blood to the brain; 2 at the front of the neck and 2 at the back of the neck. The arteries at the front of the neck are called the carotid arteries.
The carotid artery in the neck provides the main blood supply to the brain.
Diseased arteries can narrow where they divide. This narrowing or stenosis occurs because of “hardening of the arteries”.
How is carotid disease detected clinically?
Debris passing into the brain may produce a mini-stroke. A mini-stroke (transient ischaemic attack or TIA) is a small stroke which recovers within 24 hours. It can affect the face, arm or leg on one side of the body.
Sometimes there is transient blindness (Amaurosis Fugax) affecting one eye usually lasting only a few seconds. Sometimes the speech centre in the brain is affected leading to either jumbled speech or complete loss of speech.
A key feature of a TIA is that it recovers completely.
When TIA symptoms are associated with a tight narrowing of the carotid artery there is a high risk of major stroke. The risk of stroke is greatest during the first few weeks after the TIA.
When the narrowing is less severe, or when there are no symptoms, the risk of stroke is much lower.
What tests can be used to detect carotid disease?
Ultrasound is the main way of diagnosing carotid disease. Ultrasound can also be used to study the speed of blood flow at the point of narrowing.
A carotid angiogram is an Xray of the circulation to the brain taken by injecting dye (contrast) into the carotid artery. A catheter is threaded into the artery from puncture of the artery at groin level. This procedure is performed under local anaesthetic but is not performed very often because other, non-invasive imaging techniques, like ultrasound are safer.
Some patients will have a scan of the brain (CT or MRI scan). These scans can detect signs of damage to the brain caused by stroke or TIA, and rule out other causes of your symptoms. These scans can also be used to look at the arteries to the brain.
Who is at risk?
TIA’s affect those of increasing age (usually over 60 years), and are more common in men than women.
TIA’s are much more common in smokers, patients with high blood pressure, patients with diabetes and those with high cholesterol (hyperlipidaemia).
Do I need treatment?
The combination of a TIA or amaurosis fugax and a tight narrowing of the carotid artery puts you at risk of a major stroke.
In some cases it may be worthwhile treating a narrowed carotid artery in the absence of symptoms although overall the risk of stroke is less in the absence of symptoms.
If a procedure is recommended, it should be done as soon as possible after TIA symptoms, because this is the time of greatest risk for a major stroke.
The aim of treatment is to reduce the risk of major stroke posed by the tight narrowing in the neck.
Can I help myself?
You can help yourself by stopping smoking if you smoke. Regular exercise and attention to diet are beneficial. Your blood pressure, cholesterol and blood sugar should be checked, and if elevated, you should have medication to control them.
More information is included in the PDF files below which you are welcome to download and read.
If you have any questions or wish to discuss anything further, please don’t hesitate to contact us.
