Unveiling the silent threat: your guide to early detection and prevention of carotid artery disease

Stroke is the second leading cause of cardiovascular death in the United States, and up to one-third of strokes are caused by carotid artery disease. The carotid arteries supply blood and oxygen to the brain. Carotid artery disease happens when plaque builds up in the arteries over time, creating blockages that limit or block blood flow to the brain, causing a stroke.

Dr. Jayer Chung, Baylor Medicine vascular surgeon, emphasizes the importance of having regular checkups and keeping your blood pressure and cholesterol levels under control to avoid a clogged carotid artery that may lead to stroke.

“This disease is usually asymptomatic, meaning a patient will not have symptoms until they have a stroke,” he said. “However, it can be detected when a doctor hears an abnormal sound when placing the stethoscope on your neck. So, it’s important to have regular checkups to detect this life-altering disease.”

Risk factors for carotid artery disease include being male, being a smoker, having high cholesterol, high blood pressure and/or diabetes. “Any or all of these factors in some sort of combination can cause carotid artery disease,” Chung said.

Your primary care doctor may put you on drugs like statins to help lower your cholesterol, modify your diet and help you keep your sugar levels under control. Quitting smoking is essential for the health of your heart and blood vessels. Many insurance companies cover smoking cessation programs to help you quit. To schedule an appointment with the Baylor Medicine Tobacco Cessation Program, call 713-798-6376.

If your doctor notices an abnormal sound (known as a bruit) when listening to the artery in your neck, they will order more tests, including an ultrasound or CT scan, to assess potential blockages. Some patients may have a mini-stroke, which will prompt their doctor to look for blockages. If the artery does have blockages, your doctor may prescribe medications or recommend surgery.

Your healthcare provider will customize the treatment for carotid artery disease, taking into consideration:

• Your age, overall health and medical history
• The severity of the blockage
• Your exhibited signs and symptoms
• Your tolerance to specific medications, procedures or therapies
• Anticipated progression of the disease
• Your personal opinions or preferences

Dr. Chung says there are a few surgical options to remove the blockages, including carotid endarterectomy (surgery involving a cut on the patient’s neck) and minimally invasive options where a stent is placed through a thin hollow tube that is inserted into a blood vessel in the leg.

Endarterectomy

A typical carotid endarterectomy procedure usually lasts around two hours. You will receive either general anesthesia, inducing a state similar to being asleep, or regional anesthesia, allowing you to remain awake while numbing the targeted surgical area. In the case of regional anesthesia, you may also receive medication to promote relaxation.

The steps involved in a carotid endarterectomy include:

• Creating an approximately 4-inch incision at the blockage site in your neck.
• Potentially utilizing a small tube to temporarily redirect blood flow around the blockage or narrowing, isolating the specific area.
• Making an incision along the segment of the artery containing the plaque.
• Removing the plaque and closing the opening with stitches, often employing a patch made of material to widen the artery and prevent future narrowing.
• Restoring normal blood flow to the brain along its usual pathway.

Minimally invasive options

Carotid angioplasty with stenting is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in position, a balloon may be inflated to widen the artery, and a stent is placed. A stent, resembling a cylinder made of a thin metal-mesh framework, helps open the artery and restore blood flow to the brain.

Your surgeon will explain all the options, including the benefits and risks of each option, and decide what is best for you.

By Tiffany Harston, communications specialist in the Michael E. DeBakey Department of Surgery