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FACTS ABOUT CAROTID ARTERY DISEASE

Athersclerotic plaques can develop in your carotid arteries, a pair of blood vessels that deliver blood to your brain and head. With carotid artery disease, the danger is that clogged-up carotid arteries will block blood flow to your brain or bits of plaque and/or blood clot will break off and travel to the brain or eye and cause a stroke or blindness.  Because carotid artery disease develops slowly and often goes unnoticed, a stroke or transient ischemic attack (TIA), an early warning sign of a future stroke may be the first clue that you have carotid artery disease.

Treatment of carotid artery disease usually involves a combination of lifestyle changes, medications and, in some cases, surgery or a stenting procedure.

Symptoms
In its early stages, carotid artery disease often doesn't produce any signs or symptoms. You and your doctor may not know you have carotid artery disease until it's serious enough to deprive your brain of blood. If that happens, you may develop signs and symptoms such as:

If you experience any of these signs or symptoms, you may be having a stroke. Seek immediate help.  Even if the signs and symptoms last only a short while, usually less than an hour but, technically, anything less than 24 hours and then you feel normal, tell your doctor right away. What you may have experienced is a transient ischemic attack (TIA), a temporary shortage of blood to your brain.  A TIA is an important sign that you're at high risk of having a full-blown stroke, so don't ignore it.  Most people who have a stroke related to carotid artery disease have had a warning in the form of a TIA, prior to the stroke.

Causes
Normal, healthy carotid arteries, like any other healthy artery, are smooth and flexible and provide a clear pathway for blood flow. If you place a finger under your jawbone, on either side of your Adam's apple, you're likely to feel your carotid artery pulse. Your carotid arteries carry oxygen - and nutrient-rich blood to your cerebral cortex and other vital brain structures, which are responsible for your day-to-day functioning.  Over time, however, the carotid arteries can become stiff and narrow due to a gradual accumulation of plaques, a process called atherosclerosis.  Plaques consist of clumps of cholesterol, calcium, fibrous tissue and other cellular debris that gather at microscopic injury sites within the artery.  When a lot of these plaques accumulate, narrowing the carotid artery and substantially restricting blood flow.  This is known as carotid artery disease.

Risk factors for carotid artery disease
Factors that stress your arteries and increase the risk of injury, buildup of plaques and disease include the following:

When to seek medical advice
Talk to Dr. Stratienko if you have risk factors for carotid artery disease. He may do some tests to see what shape your arteries are in. Even if you don't have any signs or symptoms, your doctor may recommend aggressive management of your risk factors to protect you from stroke. If you experience signs or symptoms of a transient ischemic attack or stroke, such as numbness, slurred speech or loss of vision, seek emergency help. Just because they may go away on their own doesn't mean that they can be ignored.

Complications of carotid artery disease
The most serious complication of carotid artery disease is stroke.  There are different ways carotid artery disease can increase your risk of stroke:


Treatments options for carotid artery disease
The goal in treating carotid artery disease is preventing stroke.  The method of treatment depends on how narrow your arteries have become.  In mild to moderate cases, lifestyle changes and medications may be sufficient to prevent stroke.  If blockage is severe or if you've already had a TIA or stroke, surgery or a stenting procedure may be necessary.

Lifestyle changes
Quitting smoking, losing weight, eating healthy foods and exercising regularly are important steps in reducing the stress on your arteries and slowing the progression of atherosclerosis. Lowering the sodium content of your food also may help.  It's also key to manage any chronic conditions you may have, as prescribed by your doctor. If you have high blood pressure, it's important that you stay at or under your blood pressure goal.  Similarly, it's important to control your blood sugar levels if you have diabetes, or lower your cholesterol if you have high cholesterol levels.

Medications
Dr. Stratienko may ask you to take a daily aspirin or another blood-thinning medicine to avoid the formation of dangerous blood clots. He may also recommend medications to control your blood pressure, such as angiotensin-converting enzyme (ACE) inhibitors or calcium channel blockers, or a statin medication to lower your cholesterol.

Procedures
If narrowing in a carotid artery is severe, and especially if you've already experienced a TIA or stroke, it's best to open up the artery and remove the blockage.  There are two ways to do this:

Carotid endarterectomy
This surgical procedure is the most common treatment for severe carotid artery disease.  The procedure is done under either local or general anesthesia.  After making an incision along the front of your neck, your surgeon opens the affected carotid artery and removes the plaque.  The artery is repaired with either stitches or a graft.  Most people are discharged from the hospital within 48 hours after the operation.  The risks are low, even in adults over 80 years old, as long as they are in good health.  Studies have also shown that the surgery has lasting benefit and that it helps prevent strokes.

Carotid stenting
In some cases, a carotid endarterectomy isn't feasible because the location of the narrowing or blockage is too difficult to access directly. Also, certain conditions, such as severe heart or lung disease, prior neck operations or radiation for neck tumors, or kidney failure, may make surgery too risky. In such cases, Dr. Stratienko may recommend and perform a balloon procedure called carotid stenting (Dr. Stratienko performed the first carotid stent procedure in Chattanooga in 1997.)

After you've received a local anesthesia, your doctor inserts a long hollow tube (catheter) in your groin artery and threads it through your blood vessel network to the narrowed carotid artery.  A tiny balloon at the end of the catheter is inflated to open the narrowed area, and a metal stent - a kind of wire-mesh tubular scaffolding - is inserted to keep the artery from narrowing again.  In many instances, the doctor will place a tiny filter, also called an embolic protection device or distal protection device, above the stent to trap any plaque fragments (emboli) that may break loose during the procedure and inadvertently cause a stroke.  After the stent is in place, the protective device is removed.  You're usually discharged from the hospital the next day.  Most people are able to resume normal activities when they get home.

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Cardiac and Vascular Associates
Chattanooga Heart, Lung and Vascular Center
1032 McCallie Ave., Suite 200
Chattanooga, TN 37403-2836
Phone: (423) 693-2400
FAX: (423) 693-2499
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