Carotid Artery Disease: Artery Blockage Increasing Risk of a Stroke

There are many different processes that can
cause carotid artery disease, but by far themost overwhelmingly common is atherosclerosis,
which is the same kind of biologic processthat affects heart arteries, or might affect
leg arteries, or other arteries throughoutthe body. Atherosclerosis is a process whereby a blockage
occurs, and that blockage in the carotid arterycan predispose someone to stroke. And so if we find the blockage in the carotid
artery, the narrowing, it’s called a stenosis. If we find that stenosis, and we’re able to
intervene, we reduce patient’s long-term riskof stroke. Patients who are most likely to suffer from
carotid artery disease are patients who haverisk factors for atherosclerosis; high blood
pressure, coronary artery disease, high cholesterol,family history of having artery problems. Generally, patients have the inability to
move or feel their arm or leg. They may be unable to speak. They may have facial drooping. They also may have a condition of fleeting
blindness. Those are all signs and symptoms of carotid
artery disease that should be discussed witha doctor right away. Carotid artery disease can be treated in one
of generally three ways; medical management,in which patients are put on antiplatelet
therapy, which is aspirin, and we have somenewer antiplatelet agents. Carotid artery stenosis has traditionally
been treated in patients with significantstenosis by what’s called carotid endarterectomy. Clamps are placed on the carotid artery to
stop the blood flowing through the carotidartery, and the plaque, or atherosclerotic
build-up, is cleaned from the carotid artery. That’s what we have the most experience with. More recently with endoluminal, or what’s
called endovascular or less invasive techniques,carotid artery stenting has been performed. There’s a newer treatment that involves carotid
stenting, but it involves operating on thecarotid artery in a way that’s less invasive. The outcomes of this newer, what’s called
transcervical carotid artery stenting, orTCAR, are very similar to results of carotid
endarterectomy, the traditional operation. And this is a novel way that the carotid artery
is now treated in patients who might havea difficult operation, but now can have a
less invasive operation.