Contributor: Anthony Rizzo, MD
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If you have carotid artery disease, a big decision centers around when to intervene and how. This disease, as well as other vascular diseases, can be treated medically, interventionally or surgically. Let’s talk about this.
Diagnosing carotid artery disease
Through proper evaluation, a specialist can tell you if you are developing carotid artery disease and do something about it.
Here are some ways we diagnose it:
- Listening with a stethoscope. Doctors can usually diagnose carotid artery disease just by putting a stethoscope to your neck and listening for a distinctive swooshing sound called a bruit (pronounced bru-ee).
- Using a Doppler ultrasound. Another common test is a Doppler ultrasound, which shows the flow through and presence of disease in the neck arteries.
- Studying imaging. We can also do image studies, such as head and neck CTs and MRIs.
Once we confirm that you have the disease and the blood vessel is narrowed, we then need to find out how narrowed the artery actually is. That will tell us if we need to intervene or not.
If the artery is 80 to 99 percent blocked
First, we look at whether or not you have symptoms resulting from stroke or mini-strokes. This includes slurred speech, visual deficit in one eye, weakness on one side of the body, or any facial asymmetry such as a droopy mouth.
If you have no symptoms, we won’t recommend intervention until the artery is at least 80 percent blocked off.
But this isn’t a cut-and-dried metric. There are patients in good health with more than 80 percent narrowing. Some can get by with lifestyle changes, including quitting smoking, changing their diet, and getting more exercise.
Some patients may not be candidates, including high-risk patients. They may benefit from a medical management with aspirin-like drugs (Plavix® or Aggrenox®), statins or anti-hypertensive drugs.
If the artery is 100 percent blocked
What happens when a carotid artery is 100 percent blocked? It’s bad, but it’s not the end of the world. You’ve still got three other arteries supplying blood flow to the brain. The question then is what do we do about it? Should we try to clear or remove the blockage?
Well, in the absence of acute stroke, we usually do not intervene. When the artery is completely blocked, it is a risky operation so we prescribe medications and keep a close watch on your other carotid artery to make sure that the healthier one isn’t closing up too.
Treating advanced disease
Despite the known challenges, there are many cases where we can successfully treat advanced carotid artery disease and free patients from the potential of devastating strokes.
We have a number of options, including surgery, stenting and medications. There are a lot of variables and the treatment needs to be tailored to the individual patient. In short, it is not an easy choice.
If you have carotid artery disease or the risk factors for carotid artery disease, you need to look for two things when you choosing where to go for treatment. One is experience. You want a center that has seen and treated every kind of carotid artery disease where the physicians know exactly what they’re doing. Two is the full range of treatment options — from stenting to surgery.
You want the best available treatment for your particular condition. More experience and more options give you the best chance of a successful outcome.