Understanding Carotid Artery Problems

Carotid Arteries

Your heart pumps oxygen and nutrient rich blood to the rest of the body, including the brain. The brain depends on a steady supply of blood to function properly. If the brain does not receive its oxygen and nutrients, affected areas of the brain may be damaged, which can disrupt body function. Problems with the vessels that supply blood to the brain can block blood flow and greatly damage the brain.

Blood vessels called arteries carry blood from the heart to the body. The carotid arteries are the major arteries in your neck that supply your brain with blood. The common carotid arteries are located on both sides of the neck, and both divide into two branches. The internal carotid artery brings blood to the brain while the external carotid artery brings blood to the face and scalp.

Healthy carotid arteries have smooth walls and are unobstructed, enabling blood to flow easily to the brain. They provide the brain with enough blood to function properly.

A damaged artery no longer has a smooth lining, but rather a substance called plaque accumulates along its walls, so called “hardening of the arteries”. Plaque is formed when cholesterol and other particles in the blood stick to the artery wall. The buildup of plaque causes the artery to narrow, called stenosis. Stenosis reduces the blood flow to the brain. Artery damage can be caused by smoking, diabetes and high blood pressure. It also may be hereditary.

Arteries can become blocked.

How strokes happen

The buildup of plaque causes the artery’s wall to be rough allowing blood to collect and form clots. The plaque can rupture causing pieces to break off and enter the blood stream. The rupture can also cause more blood clots to form. These plaque fragments and blood clots (emboli) can travel toward the brain and block arteries. This will prevent blood from reaching parts of the brain, resulting in a stroke.

When a stroke occurs, blood flow is cut off which causes brain tissue to die and therefore, loss of brain function. Symptoms include difficulty in speaking or controlled movement, but exact symptoms depend on which part of the brain was damaged. Symptoms often occur only on the side of the body opposite of the blocked artery, not on both sides of the body. A stroke can cause serious, permanent damage.

Mini stroke (TIA)

A TIA (transient ischemic attack) is sometimes called a “mini-stroke” because it is a short episode of stroke-like symptoms. The symptoms are the same as a stroke but go away in 24 hours and do not cause permanent brain damage.
If you have these symptoms, get help right away. The longer you wait for medical help; the more damage the stroke can cause you. Call 911 right away if you are experiencing any of these symptoms.

  • Paralysis or weakness on one side of the body
  • Difficulty speaking
  • Numbness or tingling on one side of the body
  • Loss of vision in one eye
  • Drooping of one side of the face

Treatments for Carotid Artery Problems

Endarterectomy

Endarterectomy is the removal of plaque from the carotid artery using a small incision in skin covering the artery. The artery is opened and the plaque is removed. The incisions in the artery and skin are closed. There is a low risk of stroke or complications. Surgery usually takes 2-3 hours: you are then monitored in the recovery room or ICU overnight and discharged in 1 or 2 days from the hospital. The recovery is often quick with little pain. The procedure entails:

1. Making the skin incision. Your surgeon will make an incision on the neck over the carotid artery.
2. Opening the artery. Your surgeon will place clamps on the artery above and below the narrowing. This will prevent blood blow and allow the surgeon to make an incision in the artery.
3. Place a shunt. A shunt is usually used to preserve blood flow to the brain. After the shunt is in place, the clamps are removed. A shunt may not be needed in cases where enough blood is reaching the brain via different arteries.
4. Removing the plaque. Your surgeon will loosen plaque from the artery wall and then remove it.
5. Close incision. Your surgeon will then close the incision using a patch. The clamps are removed and a tube (drain) may be put in place to prevent fluids from collecting around the area.

Stenting

Stenting is placing a wire mesh tube (stent) in the artery to keep it open. Stenting is indicated for patients at high risk of surgery, with previous irradiation to the neck, with prior surgery of the neck and with prior nerve injury. During the surgical procedure, a long, thin tube called a catheter places the stent in the artery. This procedure uses a local anesthetic. Your doctor will need to speak with you during the procedure so you will be awake.

The doctor will insert a catheter in the groin to prepare for stenting. A local anesthetic will numb the area of insertion. A puncture is made in the femoral artery which is a major artery in the groin. A catheter is inserted and the doctor moves the catheter up the aorta, behind the heart and to the carotid using x-rays as a guide. An angiogram of the carotid artery is taken.

The Stent
A carotid artery stent is a flexible wire mesh tube. The tube may be the same width throughout or tapered. Once it is place in the artery, it will remain there. The artery stent is most often designed to resist pressure and crushing. This allows it to adjust when you move your head and neck.

If you have questions about carotid artery treatment, let us know. 
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