Living With Carotid Artery Disease

Living With Carotid Artery Disease

While most of us have heard that clogged arteries in the heart can lead to a heart attack, many people are unaware that a similar buildup in the arteries that supply blood to the brain can ultimately result in a stroke.

This accumulation of cholesterol plaque is called atherosclerosis and when it builds up in the carotid arteries – the two large vessels that go up either side of the neck and carry blood to the brain – it’s called carotid artery disease.

Fortunately, improved treatments and better understanding of the disease have reduced the number of deaths and improved the quality of life for people with this condition. If you’re newly diagnosed with carotid artery disease, know that making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis – and live a long, healthy life.

Main treatment is lifestyle changes plus medicine

I consider a number of different treatments for my patients who have carotid artery disease.

First, we usually discuss what the patient can do to keep the atherosclerosis from getting worse. This could include:

Then, to reduce the risk of stroke, we turn to medications — sometimes using different drugs for a combined approach. These medications could include statins – to modify cholesterol – and antiplatelet therapy – such as aspirin or Plavix.

Statins reduce the inflammation around the plaque. The antiplatelet agents help to reduce the stickiness of platelets and may reduce the activity along the wall of the carotid artery where atherosclerosis has begun.

In most instances, as long as the carotid artery narrowing is less than about 70 percent to 80 percent in patients without symptoms, the usual recommendation is for continued medical therapy to try to prevent the disease from getting worse.

Narrowed arteries plus symptoms require quick action

Some people with narrowing of the carotid artery also experience symptoms. The most common are being unable to move an arm or leg or loss of vision in one eye. Some people may be unable to speak. These symptoms are called transient ischemic attack (TIA) or a mini-stroke. This is a medical emergency and warrants an immediate trip to the hospital emergency room.

In most situations, if the symptoms can be taken care of quickly, and do not represent a permanent stroke, patients can have the carotid artery narrowing reduced through surgery to dramatically lower the risk of stroke. This should happen within one to two weeks after the symptoms occur.

When carotid artery disease gets worse

Despite attempts to reduce the progression of carotid artery disease, it will become worse over time for some people. When that artery narrowing becomes more than 80 percent in a patient without symptoms, most vascular surgeons would recommend surgery to improve blood flow and reduce the risk of stroke.

Because newer medical treatments that include statins were unavailable until just 15 to 20 years ago, some researchers want to understand whether surgery is necessary for patients without symptoms.

The National Institutes of Health is beginning a study – in which Cleveland Clinic will participate – to find out. The randomized, controlled clinical trial will compare treating carotid artery disease with medical therapy with revascularizations through both surgery and stenting for patients who have a high percentage of artery narrowing, but no symptoms. This study is expected to open within the next 12 to 18 months.

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Daniel Clair, MD

Daniel Clair, MD, is Chairman of the Department of Vascular Surgery at Cleveland Clinic. In 2007, Dr. Clair was named one of America’s Top Doctors.
  • Harvey

    It’d be nice to know how an informed vegan diet compares to other diets, healthwise. In terms of animal rights it’s easy to compare.

  • TV53

    I’m sorry, but there is plenty of scientific data to back diets by Esselstyn, Ornish, and others. It must drive Dr. Esselstyn crazy to read articles like this coming from his own organization. The Pritiken center has released dozens of studies over the years, and Medicare thinks enough of the Ornish diet to now provide coverage. I guess if Esselstyn’s 20 year study, and more recent 200 person study don’t qualify as data, with their remarkable results, then I guess there’s no convincing you. Then again, you recommend a low carb diet despite the enormous volume of evidence that these diets are harmful over the long run, so it’s pretty clear that this article is not taking full account of the weight of evidence. Maybe all the local doctors who end up calling Dr. Esselstyn to help with their own heart issues might have a different opinion.

  • Ken

    Sad to see this advice with little or no reference to the impact of plant based diets on preventing and curing heart diseases, especially out of the Cleveland Clinic. Is anybody there looking at all the latest research on the impact of plant based diets on heart diseases?

  • http://www.myitnet.com Duke G

    It looks like there is a typo in this sentence:Folate and B vitamins have low risk as supplements, but there is little evidence there is improvement in PAD or lowered cardiovascular risk with these agents. They also can be harmful in patients with kidney disease. Low dose intake(400g) has been recommended for overall health.
    I doubt that 400 grams is recommended. Likely milligrams – mg.

    • The_Beating_Edge_Team

      thank you for the note! We have corrected it to (400 mcg)

  • ethel burton

    hi is there anybody out there who has a vein trapped in a curved spine that as turned to bone the vascular surgeon says he cannot remove the bone as it is too dangerous but he can put a baloon inside to open up my vein so the blood can flow better

    • The_Beating_Edge_Team

      Ethel, I spoke to Dr. Clair about your question and he stated that you should have a second opinion evaluation by a physician who sees these problems regularly. If you would like to see one of our doctors or have an online second opinion, let us know. We are happy to help you. http://www.clevelandclinic.org/heartnurse betsyRN