Understanding Carotid Artery Disease

What is carotid artery disease?

Carotid artery disease is when plaque builds up in the internal carotid artery. It more commonly occurs in people who have health problems such as high blood pressure, high cholesterol and diabetes or people who smoke cigarettes. Over time, this buildup causes narrowing. Blood clots can then easily form and either block off the artery or send blood clots downstream, preventing oxygen and nutrients from getting to the brain and resulting in a stroke.

How is it diagnosed?

Unfortunately, carotid artery disease is most commonly diagnosed after a stroke occurs. However, it can be diagnosed through testing in preparation for surgery or if someone has one of the risk factors — having high blood pressure, having diabetes or smoking cigarettes. This often entails an ultrasound of the neck or a CT scan with contrast. Although, the gold standard for determining how narrow the artery has become is through an angiogram, a procedure that places a catheter inside the beginning of the artery to inject contrast in that artery specifically and capture detailed pictures.

How is it treated?

Treating carotid artery disease depends heavily on how narrow the artery has become. The more narrow it is, the more risk there is for stroke. Fortunately, managing risk factors — lowering high blood pressure and cholesterol, controlling diabetes and stopping smoking — can stop the damage and even reverse it. When it becomes particularly narrow, there are several procedures that might be recommended. The first step is an angiogram to confirm the artery’s narrowing and determine the most appropriate course of treatment. An angioplasty can be performed, which uses a balloon or stent to clear the plaque and open up the artery. Another option is carotid endarterectomy, where a neurosurgeon or vascular surgeon makes an incision into the side of the neck and in the artery to clean it out. Through either approach, the goal is the same: to open the artery back up, preventing blood clots and in turn, preventing stroke.

Brendan Eby, MD, is an assistant professor with the departments of neurology, neurosurgery and radiology at Washington University School of Medicine and the stroke medical co-director at Barnes-Jewish St. Peters Hospital. For more information, you can call 636.928.WELL.