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.
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.
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.
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.