Health screenings for patients 65 years of age and older often will include a carotid screening. Carotid screenings are included with “Welcome to Medicare” exam.
The carotid arteries are located in the neck. The common carotid artery splits to serve two purposes in the body. The external carotid artery provides blood to the face, and the internal carotid artery provides blood to the brain.
Carotid artery disease occurs when plaque builds up in the carotid arteries, which blocks the blood from being transported and can cause symptoms of a mini-stroke or stroke. If carotid artery disease goes untreated, it could result in a major stroke with long-lasting symptoms such as hemiparesis (not being able to use one side of your body), or death.
Several different risk factors for carotid artery disease include increased age, smoking, high blood pressure, high cholesterol, diabetes, and obesity.
Blindness in one eye, described as painless blindness, can look like a curtain being brought down over the eye, which can be temporary or permanent.
Weakness on one side of the body, in one arm or one leg, numbness, or tingling in one arm or one leg can occur.
Problems with speech, such as slurred speech, can occur along with a mini-stroke or stroke.
Mini-stroke symptoms last about a day or less, whereas a stroke can have lasting deficits longer than a day.
Ministrokes or transient ischemia attacks (TIAs) cannot be seen on CT scan. Strokes can typically be seen on CT scan or MRIs.
Prevention and Early Treatment
Our goal is to recognize carotid artery disease early with screenings or on a physical exam with your provider. Your provider can listen for a carotid “bruit” (brew-ee) that can be heard with a stethoscope on each side of your neck. A bruit is an abnormal noise that could represent narrowing of the artery.
Ultrasounds are necessary to determine how narrow a patient’s arteries are and are helpful to determine the next steps in treatment.
If patients do have carotid artery disease but are not symptomatic, physicians often advise taking low-dose aspirin and cholesterol medications (Statins). Also, education will be provided on smoking cessation if patients are using currently using tobacco.
If the narrowing of a carotid artery is greater than 70-80% without symptoms, surgery is recommended for the patient because the risk of stroke has significantly increased. If the carotid artery is 100% blocked on one side of the body, surgical intervention for occluded carotid artery will generally not be recommended but monitoring needs to be performed routinely on the other side for preventative care.
Patients who are already symptomatic require earlier intervention.
Another ultrasound (confirmatory duplex) on-site at Jefferson Surgical Clinic may need to be done to confirm details of a patient’s condition depending on where the first ultrasound was performed and how long ago it was performed. Sometimes, a CT scan is ordered for the patient’s head and neck to further evaluate carotid artery stenosis.
The most common surgery performed for carotid artery disease is a carotid endarterectomy. During this procedure, a 3- or 4-inch incision is made, and the artery is opened so plaque can be removed. Surgeons sew the artery back together sometimes using a patch, and patients stay overnight in the ICU before heading home the following day.
Another procedure called a Transcarotid Artery Revascularization (TCAR) is a hybrid procedure where a small incision is made for a carotid stent to be put in place. This procedure has been typically reserved for higher-risk patients or patients with prior radiation or surgery on their necks. If your surgeon deems you to be an appropriate candidate for a TCAR, you must have a CTA head and neck prior to surgery to evaluate the anatomy of your neck.
Risks with the Procedure
If a patient doesn’t have any symptoms, there is about a 3% risk of stroke during the surgery. The risk of experiencing a stroke goes up 15% every year in patients with critical carotid stenosis without surgery being performed.
Other risks can include bleeding and infection. Some patients say their neck is numb for some time after the surgery. This is a common with surgery and typically improves within six months.
These procedures and treatments are preventative and will not fix any neurological deficits patients may already have from prior stroke(s).
Patients will continue routine surveillance with ultrasounds at the direction of their provider.
Lifelong treatment with aspirin and cholesterol medicine to stabilize plaque and keep it from moving to the brain is important to prevent neurological issues for patients living with carotid artery disease.
The goal of ongoing treatment is to prevent the other side of a patient’s bodily arteries from narrowing. Keeping an eye on that side of the patient’s body through regular check-ups is important.
Need to set up an appointment or ask questions? Please call (540) 283-6000.