What is Carotid Stenosis or Stenosis of the Carotid Artery & How is it Treated?

Carotid Stenosis or Stenosis of the Carotid Artery is a pathological condition in which there gradual narrowing of the carotid arteries. This gradual process of narrowing of the carotid arteries is called as atherosclerosis. Under normal circumstances, a healthy artery is flexible and has smooth inner walls and allows the blood to pass through it smoothly without any discomfort. Due to certain conditions like hypertension or natural process of aging, or some sort of injury to the blood vessels causes a build up of a sticky substances made up of fat, cholesterol, calcium, which is known as plaque.

With passage of time, this buildup of plaque continues to increase which ultimately narrows the carotid arteries resulting in what we call as Carotid Stenosis or Stenosis of the Carotid Artery. Carotid Stenosis or Stenosis of the Carotid Artery is a condition which needs to be treated on time as if left untreated this may lead to serious complications like a stroke.

A stroke can occur due to Carotid Stenosis or Stenosis of the Carotid Artery by three ways of which one is the plaque buildup being so high that there is complete blockage of the artery and the blood is unable to flow to the brain. The second way through which a stroke can occur due to Carotid Stenosis or Stenosis of the Carotid Artery is the plaque deforming the walls of the artery resulting in formation of clots which may obstruct the blood flow to the brain, and thirdly the plaque deposits may break away from the parent block and move with the blood stream and get lodged in some of the smaller arteries blocking it and thus obstructing the blood flow to the brain.

The main cause of Carotid Stenosis or Stenosis of the Carotid Artery is atherosclerosis. This condition tends to begin in early adulthood but it usually takes many decades to actually be significant enough to cause any symptoms or damage to the individual. It is not until an individual is in his late 50s or early 60s that Atherosclerosis starts to act up causing symptoms. Atherosclerosis kicks off with damage to the inner wall of the carotid artery which can be caused due to hypertension, diabetes, smoking, and hypercholesterolemia. Other contributing factors towards atherosclerosis and ultimately Carotid Stenosis or Stenosis of the Carotid Artery are obesity, coronary artery disease, family history of carotid stenosis, and advanced age. People with already a history of a cardiac condition are more at risk for developing Carotid Stenosis or Stenosis of the Carotid Artery.

Carotid Stenosis or Stenosis of the Carotid Artery does not cause any symptoms as the process takes several years to get to a point where it is significant enough to cause symptoms. The first sign of Carotid Stenosis or Stenosis of the Carotid Artery is development of what is termed as TIA or transient ischemic attack. TIA results due to temporary interruption of blood flow to the brain with subsequent restoration spontaneously. The symptoms of a TIA may last just for a couple of minutes and then resolve. The symptoms of a TIA include weakness or numbness in an arm or leg, difficulty speaking, drooping face, vision problems, or paralysis affecting one side of the body.

In order to diagnose Carotid Stenosis or Stenosis of the Carotid Artery, the physician will first take a detailed history of the patient. This will include any symptoms that the patient might have experienced. The doctor will also inquire whether the patient has prior or current history of tobacco use or abuse and present medication use. A family history of the patient will also be taken.

Detailed physical examination will be done. If there is a detection of a bruit then it may signal that the blood flow is not smooth within the carotid artery and that is a sign of Carotid Stenosis or Stenosis of the Carotid Artery. If Carotid Stenosis or Stenosis of the Carotid Artery is suspected, then the doctor will order certain radiological studies in the form of a CT Angiogram of the neck, a Doppler Ultrasound of the neck, or a cerebral angiogram. Once these studies are completed, it will confirmatively diagnose Carotid Stenosis or Stenosis of the Carotid Artery.

The main aim of treating Carotid Stenosis or Stenosis of the Carotid Artery is to restore normal blood flow through the arteries and to reduce the risk of a stroke. The specific treatment for Carotid Stenosis or Stenosis of the Carotid Artery depends on the severity of the narrowing and how much damage has been done to the arteries by the plaque and the amount of obstruction of the arteries.

In cases where Carotid Stenosis or Stenosis of the Carotid Artery is very mild, meaning less than 50%, and there are no symptoms then medications may suffice for treating this condition. Medications are also given to those people for whom surgery is contraindicated as a result of some other medical condition. The medications given for treatment of Carotid Stenosis or Stenosis of the Carotid Artery include antiplatelet medications like aspirin which prevent formation of clots by making the blood thin, cholesterol-lowering statins which lower the risk for development of plaque in the arteries and reduce the LDL cholesterol, and antihypertensives which control the blood pressure and reduce the risk of atherosclerosis.

In cases where there is significant Carotid Stenosis or Stenosis of the Carotid Artery, then surgery is the most preferred treatment. Depending on the extent of the blockage there are different types of surgical procedures for treatment of Carotid Stenosis or Stenosis of the Carotid Artery. Surgery is also recommended for those people who have had TIA or strokes. The aim of the surgery is to remove the plaque formation and restoring normal blood flow through the artery, and correct any damage done to the artery by the plaque. Some of the surgical procedures done for treatment of Carotid Stenosis or Stenosis of the Carotid Artery are:

Carotid Endarterectomy: This is a surgical procedure done to remove plaques. In this procedure, a small incision is made over the carotid artery. The area of the stenosis is identified and the area just above and below the stenosis is clamped to block blood flow. During this time, the carotid artery on the other side of the neck carries blood flow to the brain. Now, the surgeon makes an incision in the artery over the area of the blockage and the plaque is physically peeled out and removed. The artery is then closed with tiny sutures and the clamps are removed to allow blood flow to the brain. This surgery reduces the risk of stroke by about 7% over a five year period.

Carotid Angioplasty or Stenting: This is a minimally invasive procedure in which the plaque is compressed and the artery is widened with the help of stents so that blood can flow through it smoothly without any sort of obstruction from the plaques. In this procedure, a flexible catheter is advanced from the femoral artery to the location of the plaque in the carotid artery. Next, a small balloon tip catheter is positioned across the plaque. When the balloon is opened, it widens the artery and compresses the plaque. The balloon is then deflated and removed. At the end, a stent is placed over the plaque to keep the artery wide and allow the blood to flow through it smoothly. This procedure is reserved for those people who have greater than 70% stenosis or have medical contraindication towards surgical procedures.

Carotid Artery Bypass: This is a surgical procedure in which the blocked area of the artery is bypassed and the blood is rerouted. In this procedure, a length of artery or vein is taken or harvested from somewhere else in the body. It is normally the saphenous vein in the leg. The vessel graft is connected above and below the blockage such that the flow of blood is rerouted through this new artery and the blocked artery is bypassed. This procedure is only reserved for patients who have 100% Carotid Stenosis or Stenosis of the Carotid Artery.

The overall prognosis for Carotid Stenosis or Stenosis of the Carotid Artery is variable and depends totally on how the patient follows up with the recommendations of the physician. Changes in lifestyle like abstaining from smoking and alcohol, checking blood sugar and blood pressure diligently and maintaining a health and balanced diet as prescribed by the physician improves the prognosis to a significant degree. It is also seen that even after carotid endarterectomy here is recurrence of Carotid Stenosis or Stenosis of the Carotid Artery which may require a repeat surgery to treat recurrent Carotid Stenosis or Stenosis of the Carotid Artery.