The carotid arteries are blood vessels that carry oxygen-rich blood away from the heart to the brain. Carotid arteries are important because they supply blood to the part of the brain that controls thinking, speech, personality, and the ability to feel and move. Carotid arteries are located on each side of the neck. You can feel them throb by placing your fingers gently on either side of your neck, just under your chin.

The brain survives on a continuous supply of oxygen and glucose carried to it by blood. Carotid artery disease is the narrowing or blockage of these arteries (stenosis) due to plaque build-up (atherosclerosis). The plaque can then crack, and develop an irregular surface, which is when it begins to cause problems.

If a piece of plaque or a blood clot breaks off from the wall of the carotid artery it can block the smaller arteries of the brain. When blood flow to the brain is blocked, the result can be a transient ischemic attack (TIA), also known as a ‘ministroke”. A ministroke is like a stroke, but the symptoms are temporary and can last from a few minutes to 24 hours. According to the National Stroke Council, more than half of strokes in the U.S. occur because of CAD.  Common symptoms of TIA include brief attacks of weakness, clumsiness, numbness or pins and needles of the face, arm or leg on one side of the body. The eye can also be affected resulting in loss of vision in one eye. This is called Amaurosis Fugax.

Carotid artery disease is one of the most common causes of stroke. More than half of the strokes occur because of carotid artery disease.

For many people, a TIA is the first obvious sign of arterial disease. Symptoms of stroke and TIA are similar and may include:

• Blurring, dimming, or loss of vision
• Tingling around the mouth or difficulty with speech
• Inability to move an arm or leg normally
• Numbness in part of the body
• Rarely, a sudden, severe headache

A TIA is a strong warning sign. The symptoms may resolve, but when a TIA occurs, it increases the risk of a stroke. A TIA should be treated as a medical emergency. If you think you are experiencing a stroke or TIA, get medical attention immediately!

CAD is often first detected during a routine exam. Doctors can hear sounds called carotid bruits with a stethoscope. Imaging tests then can assist in diagnosing CAD. These tests include:

• Carotid artery duplex scan—an ultrasound examination of the neck arteries • Angiogram, which can detect blockages on images taken when a contrast dye is injected into the blood vessels. Options include:
• Magnetic resonance angiogram (MRA)
• Standard (X-ray) angiogram

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

If a carotid artery is less than half narrowed, it is often treated with medicine and lifestyle changes. If the artery is between 50% and 70% narrowed, medicine or surgery may be done.

Medical treatment may include the information below:

Lifestyle changes

• Quitting smoking. This can reduce the risk for carotid artery disease and cardiovascular disease. All nicotine products constrict the blood vessels. This includes electronic cigarettes. This decreases blood flow through the arteries.
• Lowering cholesterol. Eat a low-fat, low-cholesterol diet. Eat plenty of vegetables, lean meats (no red meats), fruits, and high-fiber grains. Don’t eat processed foods, or foods high in saturated and trans-fats. When diet and exercise are not enough to control cholesterol, you may need medicines.
• Lowering blood sugar. High blood sugar (glucose) can cause damage to the lining of the carotid arteries. Control glucose levels through a low-sugar diet, and regular exercise. If you have diabetes, you may need medicine or other treatment.
• Exercising. Lack of exercise can cause weight gain. It can raise blood pressure and cholesterol. Exercise can help you keep a healthy weight and reduce risks for carotid artery disease.
• Lowering blood pressure. High blood pressure causes wear and tear and inflammation in blood vessels. This raises the risk for artery narrowing. Blood pressure should be below 140/90 mm/Hg for most people. People with diabetes may need even lower blood pressure.

Medicines

Medicines that may be used include:

• Antiplatelets. These medicines make platelets in the blood less able to stick together and cause clots. These medicines include aspirin, clopidogrel, and dipyridamole.
• Cholesterol medicines.  Statinsare a type of medicines that lower cholesterol. They include simvastatin and atorvastatin. Studies have shown that some statins can decrease the thickness of the carotid artery wall. This can increase the size of the opening of the artery.
• Blood pressure medicines. Several types of medicines work to lower blood pressure.

If a carotid artery is narrowed from 50% to 70%, you may need stronger treatment, especially if you have symptoms.

Surgery is usually advised for carotid narrowing of more than 70%. Surgery lowers the risk for stroke after symptoms such as TIA or minor stroke.

Types of surgery include:

• Carotid endarterectomy (CEA). This is surgery to remove plaque and blood clots from the carotid arteries. CEA may help prevent a stroke in people who have symptoms and a narrowing of 70% or more.
• Carotid artery angioplasty with stenting (CAS). This is an option for people who are unable to have CEA. It uses a very small tube (catheter). This tube is put into a blood vessel in the groin. It is pushed up to the carotid arteries. Once the tube is in place, a small balloon is inflated at the tip of it. This opens the artery. Then a stent is put in place. A stent is a thin, metal-mesh tube. It is used to hold the artery open.

You can prevent or delay the disease like you would prevent heart disease. This includes:

• Diet changes. Eat a healthy diet It should include plenty of fresh fruits and vegetables. Eat lean meats such as poultry and fish Eat low-fat or non-fat dairy foods. Limit your intake of salt, sugar, processed foods, saturated fats, and alcohol.
• Exercise. Aim for 40 minutes of moderate to vigorous physical activity at least 3 to 4 days per week, or as directed by your healthcare provider.
• Manage your weight. If you are overweight, take steps to lose weight.
• Quit smoking. If you smoke, break the habit. Enroll in a stop-smoking program. This can improve your chances of success. Ask your healthcare provider about prescription medicine.
• Control stress. Learn ways to manage stress in your home and work life.

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you have end-stage renal disease with dialysis access related problems, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.