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Carotid Stenosis

 

What is Carotid Stenosis?


Carotid stenosis refers to the blockage and narrowing of the carotid artery in the neck. The Carotid artery supplies blood to the brain. This blockage is causes by fatty build up called plaque and is also referred to as atherosclerosis. This fatty material accumulates in the inner lining of blood vessels and results in narrowing, stenosis and irregularity of the artery. This may result in the formation of blood clots which dislodge and flow up to the brain.

A stroke occurs when the blood flow to the brain is interrupted resulting in a loss of nutrients and oxygen. If the blood flow is not restored the brain cells die and there will be permanent brain damage. Stroke is a major cause of disability and death. Carotid stenosis is one of the many causes of stroke.




Picture showing Carotid Stenosis.



 

What causes it?


There are many risk factors associated with carotid stenosis.

  1. Age, the older you are the higher the risk.
  2. High blood pressure. This should be treated and maintained below 140/90.
  3. Smoking. This increases the risk of carotid stenosis and stroke.
  4. High cholesterol levels. High blood levels specifically of LDL can accelerate development of carotid stenosis.
  5. Diabetes or high blood sugar.
  6. Obesity. This increases the risk of high blood pressure as well as increases the development of atherosclerosis.


 

What are the symptoms?


The exact symptoms depend on the area of the brain affected, although many patients are asymptomatic and the stenosis is discovered on clinical exam. Patients may present with a transient ischemic attack (TIA). This cerebrovascular event lasts seconds to hours, but less than 24 hours. This temporary blockage of the blood vessel may cause momentary loss of vision in one eye, weakness/numbness of one side of the body, slurred speech or an inability to get words out.

It is important to consult a physician immediately as this may lead to a major stroke.



 

How is this diagnosed?


A physician may be able to hear a noise over the carotid artery with a stethoscope. This noise is called a carotid bruit and is made by blood flowing past an area of turbulence. Some other diagnostic tests include:

  • Doppler Ultrasound. This noninvasive test uses ultrasound waves to reconstruct an image of the carotid arteries and the blood flow through the arteries.
  • MRI/MRA. These tests use magnetic fields to generate an image.
  • Angiography. test is currently considered the 'gold standard', but involves some risk. Pictures are taken of the blood vessel while a dye is injected.


 

What is the Treatment?


This carotid stenosis may not cause any symptoms at call and therefore treatment indications for asymptomatic stenosis are less firm than for symptomatic stenosis.



 

Carotid Revascularization Endarterectomy versus Stent Trial (CREST)


Neurosurgeons and Interventional Neuroradiologists at Toronto Western Hospital will be participating in this trial. This multi-center controlled trial will compare carotid angioplasty/stenting to carotid endarterectomy in symptomatic carotid stenosis.