CONDITIONS

Carotid artery disease and stroke

OVERVIEW

Carotid artery disease is caused by a build-up of plaque deposits inside the carotid arteries, the main arteries in your neck that supply blood to your brain. When too much plaque builds up in these arteries, it can constrict and narrow the artery, this is known as carotid stenosis. Small clots(deposits) can break off from this plaque and travel to your brain, temporarily interrupting the blood supply to your brain. This is known as a stroke. A stroke can be major or minor and can lead to temporary or permanent disability and even death in severe cases. Temporary disability due to carotid artery disease is known as a transient ischeamic attack (TIA).

Those with carotid artery disease are thus at high risk of developing a TIA or stroke, and while treatment of carotid artery disease usually involves a combination of lifestyle changes and medication, vascular surgery may be advised to prevent a stroke.

WHAT ARE THE SYMPTOMS OF CAROTID ARTERY DISEASE?

In the early onset of carotid artery disease, there are usually no symptoms. In most cases, a TIA or stroke is the first sign of carotid artery disease.
Signs and symptoms of a stroke or TIA include:

  • Sudden weakness or numbness in the face, arms or legs
  • Sudden problems with speech and comprehension
  • Sudden vision loss
  • Sudden severe headache

Emergency care is needed for a stroke, even if it only lasted for a short while as this may have been a transient ischemic attack – which is a key sign that a more significant stroke may occur without treatment.

The risk factors for carotid artery disease include high blood pressure, high cholesterol, smoking and diabetes, among others. Those who have risk factors for carotid artery disease should see their doctor and have the carotid arteries in the neck investigated so that significant narrowing can be detected. You may also be a candidate for vascular surgery to protect you from having a stroke in the future.

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TREATMENT & STROKE PREVENTION

A narrowed carotid artery raises the chances of a stroke occurring in the future and should be closely monitored. Medical treatment is aimed at reducing your cardiovascular and carotid risk factors. Despite medical treatment, some patients may still suffer a stroke. Following a stroke, urgent vascular assessment of your carotid arteries and treatment may be indicated to prevent further strokes. In the case of a TIA, a warning sign that a more significant stroke may occur, surgery for stroke prevention is even more beneficial.

The options for surgery include open surgery and endovascular surgery: Open surgical treatment, known as carotid endarterectomy, involves opening and clearing your carotid arteries of the plaque build-up and removing any/all plaque that may cause future strokes. This procedure is performed in the operating theatre under general anaesthetic. The incisions are small, the recovery quick and it offers excellent long-term results for stroke prevention.

Endovascular treatment, known as carotid artery stenting, involves placing a stent in the narrowed segment of the artery. This is performed in the CathLab under conscious sedation and has a much shorter length of hospital stay with rapid recovery.

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