What is carotid artery disease?

As you age, plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up this plaque. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries . Eventually, enough plaque builds up to reduce blood flow through your carotid arteries, or cause irregularities in the normally smooth inner walls of the arteries.

Your carotid arteries are located on each side of your neck and extend from your aorta in your chest to the base of your skull. These arteries supply blood to your brain.

Carotid artery disease is a serious issue because clots can form on the plaque. Plaque or clots can also break loose and travel to the brain. If a clot or plaque blocks the blood flow to your brain, it can cause an ischemic stroke, which can cause brain damage or death. If a clot or plaque blocks a tiny artery in the brain, it may cause a transient ischemic attack, also known as a mini-stroke.

To remove plaque in your carotid arteries and help prevent a stroke, your physician may recommend a carotid endarterectomy. Carotid endarterectomy is one of the most commonly performed vascular operations, and is a safe, well-established, and long-lasting treatment.

 What are the symptoms?

• Carotid artery disease may not cause symptoms in its early stages.
• Unfortunately, the first sign of carotid artery disease can be a stroke.
• You may experience warning symptoms of a stroke called transient ischemic attacks, or TIAs.

Symptoms of a TIA

TIAs  usually last for a few minutes to 1 hour and include:

 • Feeling weakness, numbness, or a tingling sensation on one side of your body,  for example in an arm or a leg
 • Being unable to control the movement of an arm or a leg
 • Losing vision in one eye (many people describe this sensation as a window shade coming down)
 • Being unable to speak clearly

These symptoms usually go away completely within 24 hours. However, you should not ignore them.  Having a TIA means that you are at serious risk of a stroke in the near future. Report TIA symptoms to your physician immediately.

If TIA symptoms last longer than a few hours, or don't resolve within 24 hours, contact your physician immediately. It is likely that you have had a stroke.

Am I a candidate for carotid endarterectomy?

You are eligible for the procedure if you have severe narrowing of your carotid arteries, especially if you are experiencing transient ischemic attacks and otherwise are in reasonably good health. You may be eligible, but at a relatively increased risk, if you have:

• Had a large stroke without recovery
• Widespread cancer with a life expectancy of less than 2 years
• High blood pressure that has not been adequately controlled by lifestyle changes or medications
• Unstable angina (chest pains)
• Had a heart attack in the last 6 months
• Congestive heart failure
• Signs of progressive brain disorders, such as Alzheimer's disease

What can I expect?

Your physician or vascular surgeon will give you the instructions you need to follow before the surgery, such as fasting.

Before your vascular surgeon performs a carotid endarterectomy, he or she may want to determine teh amount of plaque buildup in your arteries. The most common test used for this purpose is duplex ultrasound. Duplex ultrasound uses high-frequency sound waves to show your blood vessels and measure how fast your blood flows. Other tests your vascular surgeon may use include:

• Angiography
• Magnetic Resonance Angiography (MRA)
• CT scan

• Once you are asleep, your surgeon will shave the skin on your neck where he or she is going to make an incision, to help prevent infections.

• Your surgeon then makes the incision on one side of your neck to expose your blocked carotid artery.

• Your surgeon then temporarily clamps your carotid artery to stop blood from flowing through it. During the procedure, your brain receives blood from the carotid artery on the other side of your neck. Alternatively, your surgeon can insert a shunt to detour the blood around the artery that is being repaired.

• After your surgeon clamps your carotid artery, he or she makes an incision directly into the blocked section.

• Next, your surgeon peels out the plaque deposit by removing the inner lining of the diseased section of your artery containing the plaque.

• After removing the plaque, your surgeon stitches your artery, removes the clamps or the bypass, and stops any bleeding. He or she then closes your neck incision and the procedure is complete. Sometimes, a patch is used to widen the artery.

• The procedure lasts for about 2 hours. 

After the procedure:

• You may stay in the hospital for 1 to 2 days. During this time, your physician will monitor your progress.  Initially, during your recovery, you will receive fluid and nutrients through a small, thin tube called an intravenous (IV) catheter.

•  Because the neck incision is so small, you may not feel significant pain.

• After you go home, your physician may recommend that you avoid driving and limit physical activities for several weeks. You can usually begin normal activities again several weeks after the operation.

• If you notice any change in brain function, severe headaches, or swelling in your neck, you should contact your physician immediately.

Are there any complications?

• You may have complications following any surgical procedure.

• A stroke is one possible complication following a carotid endarterectomy. This risk is very low, ranging between 1 and 3 percent.

•  Another unusual complication is the re-blockage of the carotid artery, called restenosis that may occur later, especially if you continue to smoke cigarettes.

• Temporary nerve injury, where you might experience numbness in your face or tongue, is another uncommon, but possible, complication. This usually clears up in less than 1 month and usually doesn't require any treatment.

STROKE

What is Stroke?

A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain.

The symptoms of a stroke include:

• sudden numbness or weakness, especially on one side of the body;
• sudden confusion or trouble speaking or understanding speech;
• sudden trouble seeing in one or both eyes;
• sudden trouble with walking, dizziness, or loss of balance or coordination;
• sudden severe headache with no known cause.

There are two forms of stroke:

• ischemic - blockage of a blood vessel supplying the brain, 
• hemorrhagic - bleeding into or around the brain.

Is there any treatment?

Generally there are three treatment stages for stroke:

• prevention,
• therapy immediately after the stroke, 
• post-stroke rehabilitation.

Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes.

Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke.

Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics

What is the prognosis?

Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia .

A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures.

Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts stroke research and clinical trials at its laboratories and clinics at the National Institutes of Health (NIH), and through grants to major medical institutions across the country. Currently, NINDS researchers are studying the mechanisms of stroke risk factors and the process of brain damage that results from stroke. Basic research has also focused on the genetics of stroke and stroke risk factors. Scientists are working to develop new and better ways to help the brain repair itself to restore important functions.  New advances in imaging and rehabilitation have shown that the brain can compensate for function lost as a result of stroke.

 Select this link to view a list of studies currently seeking patients.

Organizations

American Stroke Association: A Division of American Heart Association
7272 Greenville Avenue
Dallas, TX   75231-4596
strokeassociation@heart.org
http://www.strokeassociation.org
Tel: 1-888-4STROKE (478-7653)
Fax: 214-706-5231

Brain Aneurysm Foundation
12 Clarendon Street
Boston, MA   02116
office@bafound.org
http://www.bafound.org
Tel: 617-723-3870 888-BRAIN02 (272-4602)

Brain Attack Coalition
31 Center Drive
Room 8A07
Bethesda, MD   20892-2540
http://www.stroke-site.org
Tel: 301-496-5751
Fax: 301-402-2186

National Stroke Association
9707 East Easter Lane
Englewood, CO   80112-3747
info@stroke.org
http://www.stroke.org
Tel: 303-649-9299 800-STROKES (787-6537)
Fax: 303-649-1328

Stroke Clubs International
805 12th Street
Galveston, TX   77550
strokeclubs@earthlink.net
Tel: 409-762-1022

 National Aphasia Association
7 Dey Street
Suite 600
New York, NY   10007
naa@aphasia.org
http://www.aphasia.org
Tel: 212-267-2814 800-922-4NAA (4622)
Fax: 212-267-2812

Children's Hemiplegia and Stroke Assocn. (CHASA)
4101 West Green Oaks Blvd., Ste. 305
PMB 149
Arlington, TX   76016
info437@chasa.org
http://www.hemi-kids.org
Tel: 817-492-4325

Hazel K. Goddess Fund for Stroke Research in Women
785 Park Avenue
New York, NY   10021-3552
info@thegoddessfund.org
http://www.thegoddessfund.org
Tel: 212-713-6789
Fax: 212-698-5629

 Heart Rhythm Foundation
1400 K Street, NW
Suite 500
Washington, DC   20005
support@heartrhythmfoundation.org
http://www.heartrhythmfoundation.org
Tel: 202-464-3404
Fax: 202-464-3405

American Health Assistance Foundation
22512 Gateway Center Drive
Clarksburg, MD   20871
info@ahaf.org
http://www.ahaf.org
Tel: 301-948-3244 800-437-AHAF (2423)
Fax: 301-258-9454