Carotid Stenosis, Carotid Artery Disease w/ Dr. Lincoln Jiménez

Carotid Stenosis, Carotid Artery Disease w/ Dr. Lincoln Jiménez


Hello, I’m Dr. Lincoln Jiménez, and I would
like to talk to you about carotid artery disease. Carotid artery disease, also known as carotid stenosis, is a serious condition that affects thousands of Americans each year. It affects both men and women. Carotid artery disease is important to understand,
because it can lead to a major stroke. About 15 percent of all strokes are caused
by carotid artery disease, and these strokes can result in permanent disability or death. You have a carotid artery on each side of
your neck. These arteries begin at the base of the neck and go up into the brain. As each carotid artery enters the brain, it
branches off into the internal and external carotid arteries. The internal carotid arteries are the ones
we are most concerned about, because they are the ones that tend to become narrow or to clog. And occasionally lead to stroke. Th ere are two common scenarios that may lead to stroke. In the first scenario, which is the most common, there is an accumulation of cholesterol and calcium plaques inside the artery. The buildup eventually will cause enough narrowing – or stenosis – that the flow of oxygen-carrying blood is restricted. In the second scenario, a piece of plaque
along the carotid artery wall can break loose, flow down the bloodstream, and lodge inside
a smaller blood vessel. Both of these scenarios can cause inadequate
blood flow to the brain, which can result in a stroke. Strokes like these that are caused by a blockage
or narrowing are called ischemic strokes. Risk factors for carotid stenosis include
smoking, uncontrolled cholesterol, obesity, and diabetes. High blood pressure and family history also
may be associated with carotid artery disease. If you smoke, the most important thing you
can do to reduce your risk of carotid artery disease – and stroke – is to quit. We all know that quitting is difficult, so
talk to your doctor about resources that can help you be successful. Reducing your risk is important because doctors
do not screen for carotid artery disease. Furthermore, the disease rarely causes symptoms. As a result, patients usually do not know
that they have carotid artery disease until they have suffered a stroke or transient ischemic
attack. When we do discover carotid stenosis prior
to a stroke, we usually find it in patients who are having some dizziness. If we have ruled out other reasons for the
dizziness, we use diagnostic tests to determine whether there is narrowing, or stenosis, of
the carotid arteries. The most common diagnostic test is the carotid
ultrasound. We place a probe at the neck area, and this
enables us to evaluate the blood flow, how narrow the carotid artery is, whether a plaque
is reducing blood flow and, if so, how stable it is. We also have more invasive imaging tools. We can inject contrast agent through the vein
and then examine the patient’s arteries with a CT or MRI machine. These tests – called CT and MR angiography
— help us visualize the carotid artery in relationship to other anatomical landmarks,
such as the jaw and the back of the neck. Finally, we can perform a diagnostic angiogram
in the hospital. In this test, we insert a catheter into the
groin and thread it all the way up to the carotid artery to see in better detail what is going on. How do we manage carotid artery disease? That depends on the person and his or her
background and medical conditions. It also depends on how narrow is the carotid artery. Our goal is always to determine what is best
for the patient. Once we do this, we can either give the patient
medications to improve blood flow or perform a surgical or minimally invasive intervention. Interventional options include an open surgery
called an endarterectomy. During this procedure, a vascular neurosurgeon
makes an incision in the neck, exposes the carotid artery, and manually removes the plaque. If patients are not able to tolerate this
type of surgery, we may treat them with an endovascular – an in-the-artery – approach
called carotid angioplasty or stenting. During this procedure, a flexible catheter
is advanced from the femoral artery in the groin up to the carotid artery. Using the catheter, the surgeon opens an inflatable
balloon, which dilates, or widens, the artery and presses the plaque against the artery
wall. The balloon is then deflated and removed,
and a stent, which is in the shape of a mesh tube, is inserted to hold the plaque firmly
against the artery wall. In additio n to these treatments, patients
are strongly encouraged to make lifestyle modifications. These include adopting a healthy, plant-based diet, engaging in appropriate exercise, and putting an end to any tobacco use. I hope this video has answered some of your
questions about carotid artery disease. If you would like more information, please visit us at Mayfieldclinic.com