What is carotid artery stenosis? How is carotid artery stenosis diagnosed and evaluated? How is carotid artery stenosis treated? Imaging tests to diagnose, localize and measure stenosis include: Carotid ultrasound including Doppler ultrasound : This test uses sound waves to create real-time pictures of the arteries and locate blockages.
Doppler is a special ultrasound technique that can detect areas of restricted blood flow in the artery. Computed tomography angiography CTA : CTA uses a CT scanner to produce detailed views of the arteries anywhere in the body — in this case, in the neck.
The test is particularly useful for patients with pacemakers or stents. Cerebral angiography : Also known as intra-arterial digital subtraction angiography IADSA , cerebral angiography is a minimally invasive test in which a catheter is guided through an artery in the groin to the area of interest in the brain. Contrast material is injected through the tube and images are captured with x-rays.
If blockage is mild to moderate, lifestyle modification and certain medications may be recommended to slow the progression of atherosclerosis: Lifestyle changes: Recommendations include quitting smoking, losing weight, dietary modifications to include healthy foods, reducing salt and exercising regularly.
Medication to control blood pressure or lower cholesterol: Your doctor may also recommend taking a daily aspirin or other blood-thinning medication to prevent blood clots. If blockage is severe, surgical treatment may be recommended: Carotid endarterectomy: Severe cases of stenosis often require carotid endarterectomy. A surgeon makes an incision to remove plaque and any diseased portion of the artery while the patient is under general anesthesia.
Carotid artery angioplasty and stenting : A less invasive option used for severe stenosis. During this procedure, the doctor threads a catheter from an incision in the groin to the site of the blockage.
Once there, they inflate a balloon tip to open the artery. The doctor may place a stent in the artery to expand it and hold it open. Send us your feedback Did you find the information you were looking for? Yes No. Conventional cerebral angiography may also be needed at times; while an invasive study, it is relatively low risk, and provides the best high-resolution pictures of the arteries. Sometimes a stenosis, particularly if asymptomatic, can be managed without surgical intervention.
Typically, a physician will recommend very important measures, including medications, to control blood pressure and lower cholesterol. Smoking cessation is also very important, as it contributes to this disease. If the stenosis is significant, surgical intervention may be recommended. This typically entails one of two procedures: carotid endarterectomy or carotid angioplasty with stenting. Carotid endarterectomy entails an open surgery of the neck during which the surgeon opens the carotid artery and physically cleans out the plaque, sewing it closed at the end.
Carotid angioplasty and stenting entails performing an angiogram during which a balloon is advanced within the artery and inflated to open the narrowing in the artery from the inside.
A stent is then left in place to keep the artery open. The goal of treatment is to reduce the risk of stroke. Treatment options vary according to the severity of the arterial narrowing and whether you are experiencing stroke-like symptoms or not. People who have a medical condition that would increase the risk of surgery also are likely to be treated with medication.
Medications include:. Surgical treatment is generally recommended for patients who have suffered one or more TIAs or strokes and who have a moderate to high grade of carotid stenosis [2,3]. The aim of surgery is to prevent stroke by removing or reducing the plaque buildup and enlarging the artery lumen to allow more blood flow to the brain. Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective.
Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Depending on your risk factors, your physician may ask you to stop smoking, limit heavy alcohol consumption, maintain good blood-sugar control if you have diabetes , have your cholesterol checked regularly, and take medications as prescribed.
Do not ignore the early warning signs! After carotid endarterectomy, restenosis can occur in less than two years and is usually not symptomatic. These regrown plaques can be treated with angioplasty and stenting.
After two years, restenosis is more often related to progression of atherosclerotic disease. Plaques are composed of cholesterol and other lipids, inflammatory cells, and calcium deposits; also called "hardening of the arteries. Cholesterol is used to form cell membranes and process hormones and vitamin D. High cholesterol levels contribute to the development of atherosclerosis.
LDL cholesterol: Low-density lipoprotein cholesterol is the primary cholesterol molecule. High levels of LDL, nicknamed "bad" cholesterol, increase the risk of atherosclerosis. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider. Rapid treatment of plaque buildup atherosclerosis in the carotid arteries can greatly reduce the risk of stroke.
Through our affiliation with premier hospital systems in the Greater Cincinnati-Northern Kentucky region, Mayfield doctors care for people who have brain aneurysms, brain hemorrhages, blocked carotid arteries, moyamoya, vasospasm, and related diseases. We work collaboratively with neurologists, neuroradiologists, and neurointensivists to bring you the very best care available.
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