Cerebrovascular & Carotid
Artery Disease
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.
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.
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