The carotid arteries, located on both sides of your neck, carry oxygen-rich blood to the brain. You can feel the carotid arteries by gently feeling the pulse on the lower part of either side of your neck.
Carotid artery disease is a condition caused by the gradual clogging of these arteries with plaque. If enough plaque builds up, it can reduce or cut off blood flow to the brain. When too little oxygen reaches the brain, it can cause a stroke. Stroke is the third leading cause of death in the United States. About 25% of strokes are caused by a blocked carotid artery.
Other names for carotid artery disease: carotid artery stenosis, atherosclerosis. (Atherosclerosis is a general term for plaque buildup in any artery, not just the carotid artery.)
Carotid artery disease is caused by plaque buildup in your carotid arteries.
Plaque is made up of fatty substances, like cholesterol, in your blood. The plaque builds up slowly, over a number of years. Yet in time plaque can narrow and harden your arteries. Carotid artery disease can slow or block blood flow and cut off the oxygen supply to your tissues-specifically the brain.
Factors other than cholesterol can be involved. Carotid artery disease is generally also affected by the following risk factors. The more risk factors you have, the greater your chances of developing carotid artery disease.
Risk factors you can change
To learn more, go to the Risk Factors section and Health Conditions section (to learn about diabetes and high blood pressure).
Some people with carotid artery disease don’t have any symptoms. Others may notice the symptoms of stroke:
To find out if you have carotid artery disease, your doctor may suggest one or more of the tests listed below. The test results can also help your doctor choose the best treatment(s) for you.
In some cases you may be sent to specialists for diagnosis and testing- and sometimes for treatment. To learn more, go to the Your Treatment Team section.
Angiogram CT Scan
Doppler Ultrasound MRI
Stethoscope Test
The angiogram begins with a cardiac catheterization. During a cardiac catheterization, a small, flexible tube called a catheter is inserted into a blood vessel in your groin or arm. Your doctor gently “steers” the catheter toward your blocked blood vessel. Once the catheter is in place, your doctor injects dye to begin the angiogram. The dye allows your blood vessels to show up as images on a monitor-almost like roads on a map. If the angiogram shows a blocked artery, your doctor may be able to treat it at the time with a procedure such as balloon angioplasty.
A computerized (or computed) tomography (CAT, or CT) scan is a special type of x-ray. Although a CAT scan is used to get images of many parts of the body, let’s use the example of the heart. A traditional x-ray shows two-dimensional images
of the heart-its length and width. But a CAT scan uses an x-ray machine that moves around your body and takes multiple images of the heart. As small amounts of x-rays pass through your body, different types of tissue absorb different amounts of the x-rays. This helps provide a more precise image compared to a traditional x-ray.
The CAT scan images are viewed together on a video monitor, offering a three dimensional view- length, width, and depth. Because it is a three-dimensional image, a CAT scan offers a much better picture of the entire heart than a traditional two-dimensional x-ray can.
A CAT scan is used to detect many health conditions-tumors, for example, or bone problems like osteoporosis. As it relates to heart and blood vessel disease, a CAT scan is often used to identify:
Some types of heart disease, such as heart failure A blood vessel blockage or blood clot
When you have a computed tomography (CAT) scan, you typically undress and put on a hospital gown or sheet. You lie on an exam table. As the test begins, the table slowly moves inside a doughnut-shaped machine.
Sometimes you receive a contrast dye-usually through an intravenous (IV) line that is put into your arm. The dye allows your heart or blood vessels to show up as images on a monitor. For instance, if the test is being done to look at your blood vessels, the dye makes them visible-almost like roads on a map. You might notice some effects from the dye:
Warm flushing feeling, and maybe nausea, for a minute or so Metallic taste when the dye reaches the blood vessels in your mouth
The technician asks you to hold your body still during the scan. Sometimes pillows and/or straps help you stay in the same position. As the x-ray tube rotates around your body, the table slowly moves through the machine. You might be
asked to hold your breath at certain times during the scan. Although the CAT scan is generally not a painful test, you may feel uncomfortable from having to lie in one position during the test-anywhere from 15 to 60 minutes.
A Doppler ultrasound shows a three-dimensional, moving image of various parts of the body. This type of test is very similar to the ultrasound test done on pregnant women.
The ultrasound machine emits sound waves at a frequency that people can’t hear. As the sound echoes off of the body’s fluids and tissues, the machine records and measures how the waves are reflected back. The machine measures even tiny changes in each sound wave’s pitch and direction. As the waves “echo” off of the blood vessels, the waves show:
Doppler ultrasound shows real-time images. For instance, it shows the actual movement of blood through arteries. So doctors use the test to find blockages in various parts of the body:
Doppler ultrasound technology is also used in an echocardiogram, which is a moving image of the heart.
When you have a Doppler ultrasound, you may need to partly or fully undress and put on a hospital gown. You then lie on an exam table. The technician spreads gel on your skin on the area to be tested (for instance, the neck or leg). The gel helps transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your skin.
The machine senses the echoes of the sound waves as they reflect off of your body. The machine’s computer screen then shows the resulting image: a moving picture of your blood vessels.
Ultrasound is a painless procedure. However, you may experience some discomfort as the sonographer guides the transducer over your body, especially if you’re required to have a full bladder.
Magnetic resonance imaging (MRI) uses magnets, radio waves, and computer technology to create images of different parts of your body. MRI is especially useful in creating clear images of soft tissues. For instance, many people have an MRI to check their heart and/or blood vessels.
MRI is done in a large, tube-shaped machine. Coils inside the machine’s walls produce a strong magnetic field. Other coils inside the machine’s walls send and receive radio waves. In response to the radio waves, your body produces faint signals. As the machine senses the faint signals, a computer creates three dimensional images of the inside of your body.
The images can reveal:
Before your magnetic resonance imaging (MRI) you undress and put on a hospital gown or sheet. Before entering the MRI room, it’s important to remove any jewelry, hearing aids, or anything else with metal in it. The magnets in the MRI machine are very strong, and if you have metal on your body you could possibly be injured. Most people with a cardiac device-a pacemaker, implantable defibrillator, or heart failure device-should typically avoid an MRI. All cardiac device patients should check with their doctor before scheduling an MRI.
Once in the MRI room, you lie on a moveable table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. For instance, the technician may put contrast dye into the IV.
Patches called electrodes are put on your chest. The electrodes connect to wires on an electrocardiogram (ECG). The electrodes and ECG monitor your heart’s activity during the procedure. Often a blood pressure cuff on your arm also regularly takes your blood pressure. The table you are lying on slides into the MRI scanner, but there are no moving parts inside the machine. You wear headphones or earplugs to muffle some of the noises from the machine, which makes thumping sounds. The technician might ask you to lie very still or hold your breath for parts of the test. However, you may feel muscles twitching in your fingers or toes.
Often a very simple test can reveal a carotid artery blockage: your doctor can listen to your blood flow with a stethoscope. An abnormal whooshing sound (called a bruit) as the blood passes through the artery can signal a blockage. A
stethoscope test is a good preliminary test. Your doctor may order follow-up tests as well.
Because lifestyle factors can affect carotid artery disease, part of your treatment may include living a healthier lifestyle. If you seldom find time to exercise, for example, your doctor or nurse might suggest ways for you to start exercising more. To learn more, go to the Risk Factors section.
Other types of treatment depend on your test results. Your doctor may recommend one or more of these medications or procedures.
Anticoag uIants
Balloon Angioplasty
Endarterectomy
Stent Implant
Tips for Taking Heart Medications
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes
some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered.
Make sure you tell your doctor-or any new doctor who prescribes medication for you-about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between
medications.
You may also want to discuss these topics with your doctor or nurse each time you get a new medication:
In some cases, your heart needs several months to adjust to new medications. So you may not notice any improvement right away. It also may take time for your doctor to determine the correct dosage.
Blood tests are sometimes necessary for people who take heart medications. The blood tests help your doctor determine the correct dosage- and therefore help avoid harmful side effects.
Never stop taking your medication or change the dosage on your own because you don’t believe you need it anymore, don’t think it’s working properly, or feel fine without it.
Be sure to talk to your doctor or nurse if you have:
And don’t hesitate to ask your pharmacist if you have questions about how and when to take your medications.
You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To reduce the risk of blood clots that could lead to stroke and other medical conditions
Anticoagulants are often called blood thinners, although they don’t actually thin the blood. Rather, they help prevent clots from forming in your blood.
These medications treat conditions related to atherosclerosis, or arteries blocked by plaque. Plaque buildup can lead to a blood clot.
A blood clot in the coronary arteries (which carry blood to the heart muscle) can cause angina (chest pain). A clot or blockage in the coronary arteries is called coronary artery disease (CAD) and could lead to a heart attack.
A blood clot in the carotid arteries (in the neck) can travel to the brain and cause a stroke.
A blood clot in the vessels in the arms or legs, called peripheral vascular disease (PVD), can cause pain.
Taking anticoagulant medications can: Decrease the stickiness of the blood Reduce the likelihood of blood clots forming
A balloon angioplasty opens blocked blood vessels by pressing plaque against the artery wall. It is a procedure that uses local numbing. General anesthesia usually is not needed.
This procedure opens the artery and allows blood to flow more freely, which can reduce your:
• Risk of heart attack-in the coronary arteries
• Level of pain in your legs or arms-in the peripheral arteries
• Risk of stroke- in the carotid arteries
A balloon angioplasty typically begins with a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of the procedure. Once there is a clear image of the blockage, your doctor begins the angioplasty.
During angioplasty, the doctor uses a special catheter with a small balloon on the end. The doctor inflates the balloon near the blockage in your artery. The inflated balloon presses the plaque against the artery wall, allowing for better blood flow.
After the balloon angioplasty, your doctor may use another catheter to implant a stent. A stent is a tiny mesh tube that holds your artery open. The stent may help prevent your artery from becoming blocked again.
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the angioplasty your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight. But most people have a fairly quick recovery.
An endarterectomy is a kind of blood vessel surgery. This surgery opens blocked blood vessels by removing plaque buildup from inside the artery wall. This allows blood to flow more freely through your arteries. An endarterectomy is usually done to clear plaque from two types of vessels:
• The carotid arteries in the neck-to reduce your risk of stroke
• The peripheral arteries in the legs and arms-to relieve pain
An endarterectomy is a surgery that usually requires general anesthesia.
The endarterectomy is done at the location of the blocked blood vessel. But regardless of the location, the surgery is done the same way.
For example, to reach a blocked carotid artery, your doctor makes an incision in your neck. After finding the blockage, your doctor inserts a tube, called a shunt, above and below the blockage. The shunt re-routes the blood around the blockage during the surgery. Your doctor takes the plaque out with a special instrument. After removing the shunt, your doctor stitches your carotid artery and your incision closed.
Usually you are told not to eat or drink anything for a number of hours before your surgery. You lie on an exam table and an intravenous (IV) line is put into
your arm. The IV delivers fluids and medications during the surgery. You are then wheeled into the operating room. Usually you are given medication that makes you unconscious during the surgery. After surgery you may spend 1-2 days in the hospital. For a couple of weeks after you get out of the hospital, it’s important not to move your neck too quickly or too often.
A stent is a tiny mesh tube that helps keep an artery open. Your doctor implants a stent in a newly opened artery to reduce the risk of repeat blockage or narrowing following an angioplasty procedure. Stents are often implanted in arteries supplying blood to your heart (coronary arteries) or neck (carotid arteries). A stent implant is a procedure that uses local numbing. General anesthesia is usually not needed.
There are two kinds of coronary artery stents: bare metal and drug-coated. A drug-coated stent is a bare-metal stent coated with a special medication, or drug, to help reduce the chance of the artery becoming blocked again. The drug
coating is released from the stent over the period of time when a new blockage is most likely to happen.
A drug-coated stent implant may reduce your need for a second procedure (such as a coronary stent procedure or bypass surgery) to re-open the artery.
Before a stent implant, your doctor may open the blocked artery by performing an atherectomy or a balloon angioplasty. Those procedures-and the stent implant-involve a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel.
Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of a stent implant.
After clearing the blockage, the doctor uses a special catheter to place the stent in your newly opened artery. The stent helps:
• Hold the artery open so blood can flow freely
• Prevent plaque buildup from blocking the artery again
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious.
The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the stent implant your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight, and there may be tenderness at the incision site. Most people have a fairly quick recovery
Our knowledgeable and courteous staff will help set up a consultation for you, schedule surgical procedures, discuss your insurance, and answer any questions you may have.
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