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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia [Internet].

Carotid artery disease

Carotid stenosis; Stenosis - carotid

Last reviewed: September 20, 2013.

Carotid artery disease occurs when the carotid arteries become narrowed or blocked.

The carotid arteries provide the main blood supply to your brain. They are located on each side of your neck. You can feel their pulse under your jawline.

Causes

Carotid artery disease occurs when fatty material called plaque builds up inside the arteries. This buildup of plaque is called atherosclerosis (hardening of the arteries).

The plaque may slowly block or narrow the carotid artery. Or it may cause a clot to form suddenly. A clot that completely blocks the artery can lead to stroke.

Risk factors for blockage or narrowing of the arteries include:

Smoking (people who smoke one pack a day double their risk of stroke)

Symptoms

At early stages, you not may any symptoms. After plaque builds up, the first symptoms of carotid artery disease may be a stroke or a transient ischemic attack (TIA). A TIA is a small stroke that doesn't cause any lasting damage.

Symptoms of stroke and TIA include:

  • Blurred vision
  • Confusion
  • Loss of memory
  • Loss of sensation
  • Problems with speech and language
  • Vision loss
  • Weakness in one part of your body

Exams and Tests

Your health care provider will perform a physical exam. Your provider may use a stethoscope to listen to the blood flow in your neck for an unusual sound called a bruit. This sound may be a sign of carotid artery disease.

Your provider also may find clots in the blood vessels of your eye. If you have had a stroke or TIA, a nervous system (neurological) exam will show other problems.

You may also have the following tests:

The following imaging tests may be used to examine the blood vessels in the neck and brain:

Treatment

Treatment options include:

You may have certain procedures to treat a narrowed or blocked carotid artery:

Outlook (Prognosis)

  • Because there are no symptoms, you may not know you have carotid artery disease until you have a stroke or TIA.
  • Stroke is a leading cause of death in the U.S.
  • Some people who have a stroke recover most or all of their functions.
  • Others die of the stroke itself or from complications.
  • About half of people who have a stroke have long-term problems.

Possible Complications

Major complications of carotid artery disease are:

Transient ischemic attack. This occurs when a blot clot briefly blocks a blood vessel to the brain. It causes the same symptoms as stroke. Symptoms last only a few minutes to an hour or two, but no longer than 24 hours. A TIA does not cause lasting damage. TIAs are a warning sign that a stroke may happen in the future if nothing is done to prevent it.

Stroke. When the blood supply to the brain is partly or completely blocked, it causes a stroke. Most often, this happens when a blood clot blocks a blood vessel to the brain. A stroke can also occur when a blood vessel breaks open or leaks. Stokes can cause long-term brain damage or death.

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) as soon as symptoms occur. The sooner you receive treatment, the better your chance for recovery. With a stroke, every second of delay can cause more brain injury.

Prevention

Here's what you can do to help prevent carotid artery disease and stroke:

  • Quit smoking.
  • Follow a healthy, low-fat diet.
  • Do not drink more than 1 to 2 alcoholic drinks a day.
  • Exercise at least 30 minutes a day, most days of the week.
  • Get your cholesterol checked every 5 years. If you are being treated for high cholesterol, you need to have it checked more often.
  • Get your blood pressure checked every 1 to 2 years. If you have high blood pressure, heart disease, diabetes, or you have had a stroke, you need to have it checked more often. Ask your doctor.
  • Follow your doctor's treatment recommendations if you have high blood pressure, diabetes, high cholesterol, or heart disease.

References

  1. Brott TG, Halperin JL, Abbara S, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Vasc Med. 2011;16:35-77. [PubMed: 21471149]
  2. Brott TG, Hobson RW 2nd, Howard G, Roubin GS, Clark WM, Brooks W, et al. Stenting verses endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010;363:11-23. [PMC free article: PMC2932446] [PubMed: 20505173]

Review Date: 9/20/2013.

Reviewed by: Glenn Gandelman, MD, MPH, FACC Assistant Clinical Professor of Medicine at New York Medical College, and in private practice specializing in cardiovascular disease in Greenwich, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Extracranial‐intracranial arterial bypass surgery for occlusive carotid artery diseaseExtracranial‐intracranial arterial bypass surgery for occlusive carotid artery disease
    Patients with symptomatic occlusion (obstruction) of the carotid artery have a high risk of subsequent stroke. Anticoagulant treatment and antiplatelet agents are not very effective in these patients and a surgical procedure known as extracranial‐intracranial (EC/IC) arterial bypass surgery has been a treatment option. In this review, we included 21 trials (two randomised controlled trials and 19 non‐random studies, with a total of 2591 patients). We found that EC/IC bypass surgery in patients with symptomatic carotid artery occlusive disease was no better or worse than medical care alone. A multi‐centre trial comparing EC/IC bypass surgery with best medical treatment in patients with both a high risk of stroke and haemodynamic compromise (impaired blood flow) is underway, and aims to discover whether EC/IC bypass surgery is beneficial in this specific group of patients.
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