Carotid disease - Atherosclerotic plaque

What is carotid disease (or carotid stenosis/occlusion)?

Carotid artery disease is one of the leading causes of strokes with 20% of the cases.

Carotid arteries are the two main vessels which supply the brain with blood. The narrowing (or blockage) is created by the presence of atherosclerotic plaque. During the formation of the atherosclerotic plaque, cholesterol, fat and calcifications are deposited on the inner wall of the artery and cause its narrowing. Significant narrowing or even rupture of the plaque can cause a stroke. A reduction in oxygen supply through interruption of blood flow to the brain causes the stroke. The cerebrovascular ischemic episode can be either transient, with all symptoms disappearing, or it can leave permanent neurological damage. It is noteworthy that 1 in 6 deaths from cardiovascular causes are due to stroke.

The main risk factors are:

  1. Smoking
  2. Hypertension
  3. Age (>60 years)
  4. Diabetes
  5. Hypercholesterolemia
  6. Obesity
  7. Family history
  8. History of radiation to the neck

Symptoms

The patient usually remains asymptomatic until a stroke occurs. Stroke can be transient or permanent.

In a transient stroke (Transient ischemic attack, TIA), the symptoms last from a few minutes to a few hours, while in a permanent stroke the patient does not show improvement without medical treatment. In both cases it is necessary for the patient to seek immediate medical assistance.

Symptoms depend on the area of the brain that has a reduced blood supply or is damaged. These can be:

  1. Numbness or paralysis of upper or lower limbs
  2. Facial numbness
  3. Vision loss
  4. Difficulty speaking
  5. Difficulty with comprehension
  6. Headache
  7. Dizziness, loss of balance

Diagnosis

A thorough history and physical examination are the most important steps in the diagnosis of carotid artery disease, whether or not it is accompanied by a stroke.

Subsequently, imaging methods such as carotid duplex, CT and MR angiography are often necessary for the decision of the therapeutic method to be followed.

Treatment

The appropriate treatment depends mainly on the symptoms and the degree of carotid stenosis.

  1. Lifestyle modifications
    1. Quit smoking
    2. Weight loss
    3. Healthy diet
    4. Exercise
  2. Medication
    1. Antiplatelet agents
    2. Antilipidemic drugs
  3. Surgical treatment with carotid endarterectomy
  4. Surgical treatment with stent placement

Carotid endarterectomy

Carotid endarterectomy is the most common surgery to treat the stenosis and reduce the risk of stroke.

With an incision in the patient’s neck, the Vascular Surgeon exposes the carotid artery and cleans it of the atheromatous plaque.

The patient usually stays in the hospital for one day for observation and is then discharged with specific instructions.

The risk of complications related to the operation is discussed in detail with the patient during the visit to the office as well as before the surgery.

Stent placement

An alternative method with specific criteria for its use is angioplasty with stent placement.

The operation is performed by a puncture from the groin, where through the arterial system with special wires and catheters, a stent is placed in the carotid artery to “open” the area of the stenosis.

As in open surgery, the patient remains in the hospital for one day and is discharged with specific instructions.

Possible complications (such as the risk of stroke) are discussed with the patient in detail during the office visit and preoperatively.

Dr. Tzavellas has performed the new technique of carotid stent placement through a small incision at the base of the neck (TCAR) which provides specific advantages over traditional angioplasty. This particular technique is performed in the USA with excellent results, however it is not yet available in Europe.

Transcarotid artery revascularization (TCAR) in a patient with significant high grade carotid disease

Protect your vessels

Georgios Tzavellas, MD with his experience in treating carotid disease will discuss with you the appropriate treatment to prevent a stroke.
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