Stroke. TIA. RIND. CVA. These are all diagnostic terms that strike fear in our patients and their families. There are many causes of "strokes" and I would like to discuss one cause, specifically Carotid Artery Disease.
The carotid artery is located in the neck, and carries blood from the heart to the brain. In the neck the main (common) carotid artery splits into two arteries called the external carotid artery and the internal carotid artery. The external carotid artery and its branches supply blood to the face, and the internal carotid artery goes up into the skull and supplies the brain. Much like a fork in a river where the water swirls and churns and deposits mud and debris, the "fork" in the carotid artery in the neck creates turbulence. This swirling of blood, combined with cholesterol and atherosclerosis causes deposits of debris leading over time to narrowing of the artery and reducing blood flow to the brain. These deposits can break off and cause little mini-strokes, or a TIA. These mini-strokes serve as warning signs of impending disaster. The warning signs may consist of temporary visual changes in one eye, short term weakness of one side of the body, temporary speech changes, or a droopy face on one side. Much has been written and is available on the early warning signs of stroke. Unfortunately, sometimes the first symptom of carotid artery disease is a major permanent stroke. Much has been written and is available on the early warning signs of stroke.
The diagnosis of carotid artery stenosis is often made during routine ‘screening exams’ at a local church or event center. This consists of an ultrasound examination of the carotid artery and can identify potentially serious blockages in the carotid artery. The finding of a "bruit," an abnormal sound over the carotid artery may be heard by your physician on a routine examination and lead to further evaluation.If a blockage of the carotid artery is suspected the most precise examination of the artery can be accomplished with a CTA, an MRA or an arteriogram. Any one of these tests will allow your physician to determine the most appropriate treatment plan.
As a general rule, surgical treatment for Carotid Artery Stenosis is recommended for blockages 60 percent or greater in the Common or Internal Carotid Artery. Blockages less than 60 percent may be followed closely with repeat testing every 6-12 months, and medications used may include Aspirin and Plavix to prevent blood clots from forming on the blockage. Blockages greater than 60 percent, especially if the patient has had any of the warning signs, are considered for surgical treatment.
Currently there are two procedures available to treat the build-up of plaque in the internal carotid artery. The most common is an operation is called a Carotid Endarterectomy. A Carotid Endarterectomy is done in the operating room with general anesthesia. A three inch incision is made in the neck. During this operation the "plaque" causing the blockage is removed from the inside of the artery and a small patch placed over the artery to widen it. The risk of stroke during the operation is two percent. It takes about an hour to complete the operation. Patients stay in the hospital overnight and can resume normal activity in 2-3 days.
Those patients who have had a previous neck operation or neck irradiation, and those who are too ill for general anesthesia are considered very high risk patients. These patients are candidates for a minimally invasive procedure called Carotid Artery Stenting. This procedure is performed in the endovascular suite with the patient under very light sedation. The procedure is done without any incisions, it is accomplished through a catheter placed in the groin. The risk of stroke during this procedure is 2-5 percent, and the patient stays in the hospital overnight for observation. In this procedure a stent is placed inside the blockage, a balloon is used to push the artery open and then the stent holds it open. A small filter device is placed in the artery during the procedure to catch any pieces that might break off, and is removed at the end of the procedure. Patients can resume normal activity in 1-2 days.
At the INTEGRIS Heart and Vascular Institute in Enid, we have performed several hundred Carotid Endarterectomy operations, with a stroke rate less than two percent. We have also performed many Carotid Artery Stent procedures for those high risk patients not candidates for surgery.
For more information on either of these procedures, or if your primary care physician would like to refer you for evaluation, please contact my office at 580-616-7634.
David W. Vanhooser, M.D.
Chief, Cardiovascular Surgery
INTEGRIS Heart and Vascular Institute