Every year in the United States, approximately 800,000 strokes occur, and roughly 34% are linked to blockages in the carotid arteries. One major cause behind such strokes is carotid artery disease (also referred to as carotid artery stenosis). This condition involves the narrowing or blockage of the arteries in the neck that carry oxygen-rich blood to the brain. This narrowing is primarily due to atherosclerotic plaque (a build-up of fatty material, cholesterol, etc), which can reduce or interrupt blood flow to the brain, increasing the risk of a transient ischemic attack (TIA) or a full stroke. Hence, to better understand this silent yet serious condition, in this blog, we will explore its main causes and the most effective treatments to address it, guiding you through everything you need to know about carotid artery disease.
Carotid Artery Disease- Causes
High blood pressure (hypertension)
Consistently high blood pressure forces your arteries to work harder, which can weaken and stiffen the arterial walls over time. This damage makes it easier for fatty deposits to accumulate, increasing the risk of carotid artery narrowing and related complications.
Smoking/tobacco use
Smoking introduces harmful chemicals such as nicotine, carbon monoxide, and tar, which directly injure the inner lining of your arteries. These substances also promote the formation of fatty plaques and reduce oxygen delivery to tissues, significantly contributing as a major cause of carotid artery disease and stroke.
Diabetes mellitus
Over time, high blood sugar can damage your blood vessel walls, promoting plaque buildup and narrowing of the carotid arteries. This increases inflammation and the risk of blockages, contributing to carotid disease.
Elevated cholesterol and lipid abnormalities
High levels of low-density lipoprotein (LDL) cholesterol, low levels of protective high-density lipoprotein (HDL), and elevated triglycerides also increase plaque formation in the carotids.
Age and vascular aging
The risk of carotid artery disease increases with age as the arteries progressively lose their elasticity and become more prone to stenosis, making it another significant cause of this disease.
Sedentary lifestyle/obesity
Lack of any sort of physical activity and excess body weight also lead to many of the above risk factors (hypertension, dyslipidemia, diabetes) and thereby indirectly promote carotid artery disease.
Family history/genetics
People who have a family history of cardiovascular disease, stroke, or vascular disease are also likely to develop carotid artery disease, indicating a genetic or inherited predisposition.
Treatments For Carotid Artery Disease
Two major treatments for the disease are:
TransCarotid Artery Revascularization
TransCarotid Artery Revascularization (TCAR) is a minimally invasive carotid artery disease treatment that aims at restoring blood flow to the brain. It combines elements of traditional surgery and endovascular techniques to remove plaque and reduce stroke risk, particularly in high-risk patients.
How It Works:
The TCAR procedure involves a small incision near the collarbone in order to access the carotid artery. A catheter is inserted through this incision, and blood flow is temporarily reversed to protect the brain from potential embolic debris. A stent is then placed to open the narrowed artery, and the catheter is removed. The procedure is designed in a way to reduce surgical trauma while effectively restoring artery health.
Ideal Patients
TCAR is suitable for patients with moderate to severe carotid artery narrowing (stenosis) who are at high risk for traditional open surgery due to age, comorbidities, or any other health conditions. It is also appropriate for people who are looking for a faster recovery with reduced stroke risk.
Benefits
- It is a minimally invasive approach with smaller incisions and reduced recovery time.
- There is a lower stroke risk during surgery due to blood flow reversal, capturing plaque fragments before they reach the brain.
- The risk of cranial nerve injury compared to traditional open surgery is also reduced.
Long-Term Management
After the procedure, patients should follow up with regular imaging, take prescribed antiplatelet and cholesterol-lowering medications, and maintain a healthy lifestyle, including diet, exercise, and smoking cessation, to prevent any recurrence.
Carotid Endarterectomy
Carotid Endarterectomy (CEA) is a surgical procedure performed by an experienced carotid artery disease doctor, which involves the removal of atherosclerotic plaque from the carotid artery to improve blood flow to the brain and reduce stroke risk.
How It Works
During its process, the surgeon makes an incision in the neck to access the carotid artery. The artery is temporarily clamped, and then the plaque is surgically removed. In some cases, a patch may be sewn into the artery to widen it and improve blood flow. The artery is then closed, and the incision is sutured.
Ideal Patients
CEA is recommended for patients with symptomatic carotid artery stenosis (narrowing) greater than 50% or asymptomatic stenosis greater than 70%, particularly if they are at low to moderate surgical risk. It is also beneficial for individuals who have experienced transient ischemic attacks (TIAs) or minor strokes.
Benefits
- It allows for direct inspection and treatment of the artery, which can address complex plaque or calcifications more effectively.
- It is one of the well-established procedures which provides long-term results with a lower risk of re-narrowing.
- Also, this treatment is suitable for patients with favorable anatomy and low surgical risk.
Long-Term Management
Post-CEA care includes routine check-ups, antiplatelet and cholesterol therapy, and lifestyle modifications such as a heart-healthy diet, exercise, and quitting smoking to maintain artery health and reduce any future stroke risks.
Conclusion
It is very important to know the major causes of carotid artery disease so that one can take preventive steps and reduce the risks. However, if you or someone you know is diagnosed with carotid artery disease, it’s important to have a detailed discussion with a vascular specialist about which treatment plan is best for you, considering the individual risk factors, anatomy, etc. To make this decision easier and make sure you have the right kind of support, Vegas Vascular Specialists is there to assist you in the process. With decades of combined experience and a commitment to advanced, patient-focused care, we help you make confident decisions for your vascular health and long-term well-being.