Cerebrovascular Disease

OVERVIEW

Stroke killed 157,804 people in 2003. It’s the third largest cause of death, ranking behind “diseases of the heart” and all forms of cancer. Stroke is a leading cause of serious, long-term disability in the United States. Carotid artery stenosis is a leading cause of strokes.

You have two carotid arteries, one on each side of your neck, just next to your windpipe. These arteries supply blood to the large front section of your brain, which is responsible for thinking, speech, personality and sensory and motor functions. You also have two smaller arteries, the vertebral arteries that run up your spine and supply blood to your brainstem and cerebellum.

Just like the arteries in your heart, the carotid arteries can narrow and develop blockages. This disease process is known as atherosclerosis, and the blockages, made of fat and cholesterol deposits, are called plaque. The disease can cause a decrease in blood flow to the brain, ultimately leading to a stroke.

RISK FACTORS

The following factors may increase your chance of atherosclerosis and, as a result stroke:

• Smoking
• Family history of stroke
• Diabetes
• High blood pressure
• Race/ethnicity
• Age
• High fat/high cholesterol diet
• Prior history of stroke
• Being overweight

SYMPTOMS AND DIAGNOSIS

There are not necessarily warning signs for carotid artery disease, but there are warning signs of and impending stroke. Many times a stroke is preceded by a Transient Ischemic Attack (TIA or mini stroke). A TIA is a temporary (lasting a few minutes to a few hours) episode of any of the following events:

• Blurred of loss of vision in one or both eyes
• Weakness and /or numbness of your arm, leg or face on one side of your body
• Slurring of speech, difficulty talking or understanding what others are saying
• Loss of coordination, dizziness or confusion
• Trouble swallowing
• Headache

Note: A TIA is a medical emergency. Immediate treatment my save your life or increase your chance of a full recovery.

Sometimes a patient may not know that he or she has diseased carotid arteries. In these cases, it is important that the carotid arteries are routinely assessed as part of a regularly scheduled physical exam. Initially, the physician will listen to the carotid arteries with a stethoscope. If an abnormal whooshing sound, called a bruit (BROO-ee) is heard, disease may be present. Bruits, however, are not always present when blockage is present, and a bruit may be heard in even the most minor of narrowings. . A carotid ultrasound will determine the degree and location of blockage in the artery. This may need to be confirmed by another test such as a CT scan, an MRA or an angiogram.

TREATMENT

When a blockage is significant (generally greater than 70%) treatment is recommended.

• Carotid Endarterectomy (CEA): This surgical treatment is preformed while the patient is under general anesthesia. An incision is made in the side of the neck, at the location of the blockage (generally just below the jaw), and into the carotid artery. The plaque and any diseased portion of the artery is sewn back together to allow blood flow to the brain.
• Carotid Artery Stenting (CAS): This is a non-surgical procedure that is performed in a catheterization laboratory. A small puncture is made in an artery in the groin, and catheters and wires are inserted under specialized X-ray. During this procedure, balloons, stents (mesh-like tubes that act as scaffolding in the carotid artery) and small filters (to capture particles from the blockage and prevent a stroke) are placed in the carotid artery via the previously placed catheters and wires.