Carotid Artery Disease: Warning Signs, Stroke Risk and Who Should Be Checked

What it involves

MedlinePlus explains that the carotid arteries are two large blood vessels in the neck that supply blood to the brain and head. In carotid artery disease they become narrow or blocked, usually from atherosclerosis, a buildup of plaque made of fat, cholesterol, calcium and other substances. A piece of plaque or a clot can also break off and lodge in a smaller artery in the brain.

Who this is for

• Adults with high blood pressure, high cholesterol or diabetes who want to understand their stroke risk.
• Current or former smokers, and patients with a family history of stroke.
• People who had a brief episode of weakness, speech trouble or vision loss that went away.
• Patients with artery disease in the legs or heart who ask whether the neck arteries should be checked.

What to expect

• Questions about past episodes of weakness, speech or vision trouble, plus smoking, family history and medicines
• A physical exam, including listening over the neck arteries and checking your blood pressure
• Blood work and an EKG at the Loxahatchee and West Palm Beach offices when appropriate
• A referral for carotid ultrasound or other imaging if your provider recommends it, and a plan to lower risk

Why it is easy to miss

MedlinePlus states that carotid artery disease often causes no symptoms until the narrowing or blockage is severe. Because nothing hurts, the first sign for some people is a mini-stroke or a full stroke. A provider may hear a bruit, a whooshing sound, over the artery with a stethoscope, which is one reason a physical exam includes the neck. Since symptoms arrive late, attention to blood pressure, cholesterol and blood sugar matters well before anything feels wrong.

The mini-stroke that passes

A TIA, sometimes called a mini-stroke, happens when blood flow to part of the brain is briefly blocked. MedlinePlus says the symptoms usually go away within an hour, and that a TIA is a warning sign because it significantly raises the risk of a later stroke. Do not wait to see whether it passes. Call 911 even if the symptoms have gone, and read the stroke warning signs guide, which lists what to look for and why every minute counts.

Risk factors to work on

The same factors that raise stroke risk apply here. MedlinePlus lists high blood pressure as the main one, along with diabetes, heart disease including atrial fibrillation, smoking, older age, high cholesterol, inactivity, obesity and a personal or family history of stroke. Most can be managed at routine visits. The hypertension management page and the high cholesterol management page explain how those numbers are followed, and the quitting smoking guide covers help with tobacco.

How it is found

MedlinePlus says imaging tests can confirm carotid artery disease, including carotid ultrasound, Doppler ultrasound and MR angiography. It also lists screening for narrowing in people without symptoms as a topic for discussion with a provider. The practice does not list in-office ultrasound or MR imaging, so these tests are arranged by referral and the results are reviewed at your next visit. At the office, the visit covers your history, an exam, blood pressure, blood work and an EKG where it is offered.

Treatment and prevention

According to MedlinePlus, treatment may include healthy lifestyle changes, medicines, carotid endarterectomy, which is surgery to remove plaque, or angioplasty with a stent to hold the artery open. Surgery and stenting are decided by vascular specialists after referral. For most people the daily work is the lifestyle side: a heart-healthy diet, regular activity, a healthy weight, no smoking and control of blood pressure and cholesterol. The peripheral artery disease guide describes the same disease process in the legs.

When to call 911

MedlinePlus lists the stroke warning signs: sudden numbness or weakness of the face, arm or leg, especially on one side, sudden confusion or trouble speaking, sudden trouble seeing in one or both eyes, sudden trouble walking or loss of balance, and a sudden severe headache with no known cause. If you think you or someone else is having a stroke, call 911 right away. Do not drive yourself and do not wait for an appointment. Treatment works best when it starts fast.

Sources

• MedlinePlus: Carotid Artery Disease (health topic)
• MedlinePlus: Stroke (health topic)