Carotid stenosis is a narrowing of the lumen of the carotid artery. This artery is the main one that takes oxygen-rich blood to the brain. A lumen is the inside space of a tube such as an artery. Significant carotid stenosis occurs in 5 out of 1000 people 50 to 60 years old. It’s more common in older people: 100 out of 1000 people older than 80 have it.
The cause is usually buildup of fatty deposits called plaques (as in atherosclerosis). Less common causes are aneurysms, inflammation of arteries (arteritis), and tears (dissection) of the carotid. Fibromuscular dysplasia, tissue damage after radiation therapy (postradiation necrosis), and spasm of blood vessels (vasospasm) are others.
Risk factors include high blood pressure (hypertension), high lipid values, diabetes mellitus, and smoking.
Most people often have no symptoms until the degree of narrowing is severe. Other people may have ministrokes called transient ischemic attacks (TIAs). Most TIAs last less than 10 minutes. They’re caused when blood flow to a certain part of the brain stops for a short time. Symptoms depend on which arteries are affected. More common symptoms of TIAs include weakness or numbness on one side of the face or body (face, arm, leg). Vision changes, confusion, slurred speech, being unable to talk, and problems swallowing also occur.
The health care provider makes a diagnosis from the medical history and careful neurological examination. The health care provider listens to the carotid artery with a stethoscope for noises from abnormal blood flow called carotid bruit. Laboratory tests to measure levels of lipids (cholesterol, triglycerides) and a fasting glucose level are usually done. The health care provider will obtain an ultrasonography of the carotid arteries to evaluate the degree of narrowing of the lumen of the carotids. Angiography and magnetic resonance angiography (MRA) may be needed before surgery to better define the area that needs surgery. The health care provider may suggest seeing specialists (neurologist, vascular surgeon).
Treatment depends on the degree of stenosis and symptoms. It can be medical or surgical. Medical management includes reducing risk (stopping smoking, controlling high lipid levels and diabetes) and low-dose aspirin (81 or 325 mg daily). Surgery for carotid stenosis is called carotid endarterectomy (CEA). It’s usually done in people with recent symptoms and 70% to 99% stenosis if their life expectancy is more than 5 years. The expertise of the surgeon performing the CEA plays an important role in determining the success of the operation.
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