Carotid Artery Disease
Carotid arteries are the main arteries carrying oxygenated blood to the brain and originate from the brachiocephalic artery in the right and aorta in the left. Arteriosclerosis is the main cause of carotid artery stenosis or occlusion and may lead to stroke and paralysis.
Diagnosis of Carotid Artery Disease
Diagnosis of carotid artery disease is done mostly by carotid doppler ultrasonography. CT angiography and MRI angiography are also frequently used because they can diagnose both extracranial and intracranial atherosclerotic disease.
Treatment Options in Carotid Artery Disease
Treatment in carotid artery disease is planned according to the nature of the stenosis, presence of stroke or transient ischaemic attack or necessity for bypass surgery. Treatment is done either by percutaneous stent implantation or open surgical exploration and endarterectomy.
When Should Carotid Stenosis be Treated by Stent?
The primer target to intervene a carotid stenosis either by stent or endarterectomy is to prevent upcoming stroke or TIA( Transient Ischaemic Attack- stroke that lasts for less than a day). If a patient already had a stroke the target is to prevent recurrent stroke. Taking this into consideration following are the indications for carotid stent:
- %70 or above stenosis in carotid artery
- Stroke or paralysis within last 6 month
- Stenosis above 70% after carotid endarterectomy operation
- Stenosis in the region not amenable by endarterectomy procedure
- Patient preference after discussing all the advantages and drawbacks of carotid endarterectomy and carotid stenting
How is Stent Implanted in Carotid Stenosis?
In a catheter laboratory femoral access is used to insert a catheter and reach
carotid arteries through the aorta. After carotid artery engagement a distal
protection device( a filter that helps to capture thrombus or debris from the
carotid plaque during angioplasty and stent procedure) is parked distal to the
lesion. Then the stent is implanted and postdilated to reach the vessel diameter
if needed. Distal protection device is drawn back and the procedure is finished.
Advantages of Carotid Stent over Carotid Endarterectomy?
Carotid stenting is done on local anesthesia without any risk of sedation or intubation, procedure is almost pain free, low risk of infection or bleeding, short hospital stay and quick return to normal daily life.
Frequently asked questions about carotid arteries:
What is a carotid artery?
Carotid arteries are the arteries carrying oxygenated blood to the brain and originate from brachiocephalic arteries in the right and aorta in the left.
What is the cause of carotid stenosis?
Atherosclerosis is the main cause of carotid stenosis. Cause of atherosclerosis in carotid is multifactorial and similar to that on coronary artery( age, sex, hypertension, diabetes, hyperlipidemia, smoking, atherosclerosis in other part of body etc)
What are the symptoms of carotid stenosis?
Carotid stenosis may be either silent until totally blocked or may present with a stroke( aphasia, hemiparesis, facial paresis, hemianopsia, vertigo, change in mental status etc)
How is carotid stenosis diagnosed?
Carotid stenosis is diagnosed by color doppler USG or computer tomography angiography or magnetic resonance angiography.
Can carotid stenosis be treated by drugs?
Whenever the stenosis is under %70 the disease is treated with blood thinners, cholesterol and plaque modification drugs to prevent stroke and to decrease the
progression of stenosis. However when the lesion is above 70% durg therapy is insufficient and may need surgical or percutaneous intervention.
Is it safe to implant a stent in carotid stenosis?
Yes it is safe to implant a stent in carotid stenosis in an experienced center. The risk is similar to the alternative therapy technique carotid endarterectomy. The risk of recurrent stroke is lower in patients having intervention than in patients without intervention.
What happens if carotid disease is not treated?
If not treated in time the carotid vessel may be completely blocked or may result in TIA or stroke.
How long does a carotid stent last?
Carotid stents last forever in the carotid vessel and it is not possible to remove it. By time the inner surface of the stent is covered by endothelial tissue. Carotid is a vessel with a big diameter and high blood flow. So the stenosis is rare and whenever it happens it is possible to treat it again percutaneously.
After a carotid stent procedure what precautions should a patient
take?
It’s important that patients take rest for a few days after the procedure especially to avoid vascular access bleeding and complications. After a few days the patient can return to his regular life. Blood thinners( antiaggregant) and drugs
lowering cholesterol and stabilizing plaque( statin) should be taken as prescribed by the doctor.