Carotid Artery Stenosis (CAS) may be defined as a build up of plaque within the carotid arteries. This is the same disease process, also called atherosclerosis that causes cardiovascular disease of the heart and peripheral artery disease in the legs. The internal carotid arteries deliver blood and oxygen to the brain. The external carotid arteries deliver blood and oxygen to the face, scalp and neck. When we speak of carotid artery stenosis, it is the internal carotid artery that we are referring to. If the carotid arteries become significantly blocked, it can cause temporary stroke-like symptoms, known as transient ischemic attack (TIA) or an actual stroke or cerebral vascular accident (CVA). Here at Horizon Vascular Specialists, we are experts in the monitoring of and treatment of carotid artery disease.
Whether your physician refers you for a carotid artery evaluation or your Horizon Vascular Surgeon recommends it as a part of your vascular health screening, we would start with taking a history (asking specific questions about any neurologic symptoms you may have experienced and why your physician has referred you for evaluation), a physical exam, and a carotid artery duplex (an ultrasound of the carotids).
Carotid Artery Duplex
General testing guidelines are below but may be altered depending on your symptoms and clinical situation.
|
Degree of stenosis |
Percent of blockage |
Follow up |
|
None |
Trivial or immeasurable |
Repeat as needed with future neurologic symptoms |
|
Minimal |
< 20% |
Repeat in 1-2 years |
|
Moderate |
21-49% |
Repeat in 1 year |
|
Severe |
50-69% |
Repeat every 6 months |
|
Critical |
> 70% |
Will need intervention |
Medical Management
- The American Heart Association and the Society of Vascular Surgery recommends an antiplatelet agent (aspirin and in some cases plavix) and a statin (cholesterol medication) for general medical management. You should work with your PCP or cardiologist when initiating these medications.
- Excellent risk factor control/ modification is also recommended, just as it is for cardiovascular and peripheral arterial disease. Control your blood pressure, diabetes and cholesterol. Stop smoking. Exercise.
Surgical Intervention
The procedure recommendation will depend on the location of the stenosis along the internal carotid artery, characteristics of the plaque and your overall health and risk for general anesthesia.
- Carotid endarterectomy (open surgery) – most common intervention and appropriate for most patients
- Carotid stenting (endovascular procedure) – may be more appropriate for patients with lesions closer to the brain and for those with scarring of the neck from prior surgeries or radiation treatments.