Carotid Artery Disease Treatment in India

Carotid Artery Disease is a medical condition characterised by the narrowing or stenosis of the carotid artery (that supplies blood to the head and brain) due to the deposition of the plaques along the walls of the arteries. The fatty substance or cholesterol deposits in the artery leading to increased stroke risk.

Alternate Name of Carotid Artery Disease

Carotid artery stenosis

Carotid Artery Disease Causes

• The most prominent cause of carotid artery disease is plaque formation due to the deposition of various substances along the carotid artery wall, such as cholesterol, calcium.
• The plaque formation leads to atherosclerosis of the carotid artery. Clogging leads to stiffness and narrowing of the artery. This increases the risk of cerebrovascular stroke.

Carotid Artery Disease Symptoms

There could be no visible signs and symptoms of carotid artery disease during the initial stages. As the clogging increases, the blood supply to the brain is affected and could lead to stroke or transient ischemic attack (TIA) with the presentation of the following symptoms:

• Sudden onset of numbness or weakness in the limbs or face, usually on one side
• Sudden onset of severe headache
• Sudden loss of balance
• Sudden trouble in the vision of one or both eyes
• Sudden trouble speaking
• Sudden dizziness

Carotid Artery Disease Diagnosis

Presentation of carotid artery disease might mimic other disorders or cardiac conditions such as aortic valve stenosis, seizures, fibromuscular dysplasia, carotid artery dissection, cerebellar infarction, complex migraine headache, stroke, atrial fibrillation associated with a cardioembolic event, etc.; hence a differential diagnosis is required to rule out other possibilities.

Carotid Artery Disease Test

Typical diagnosis includes a physical examination and monitoring of vitals such as blood pressure and pulse. Your doctor monitors blood flow in your carotid artery by hearing the sound of the blood using a stethoscope placed on your neck. The doctor will also run certain blood tests to examine parameters such as calcium levels, cholesterol levels, etc. In addition, you might also be required to undergo an ultrasound, cerebral angiography, CT angiography, or magnetic resonance imaging (MRI) angiography to confirm the diagnosis.

Stages of Carotid Artery Disease

Carotid artery disease can be classified into three stages depending upon the blockage:

• Mild: Blockage of the artery is less than 50%.
• Moderate: Blockage of the artery is 50-79%.
• Severe: Blockage of the artery is 80-99%.

Carotid Artery Disease Treatment

It depends on the severity of the disease and the patient’s age. The following treatment options can be considered:

Lifestyle Changes

A timely diagnosis before the onset of stroke can be treated by lifestyle modifications such as regular exercise, managing stress, eating a balanced diet, quitting smoking, limiting alcohol use, etc.

Medications

Various medications, such as cholesterol-lowering drugs, blood pressure-lowering drugs, etc., could be prescribed to reduce the risk of developing stroke. Medications are also prescribed after the surgery to prevent recurrences.

Surgery

In the case of stroke, surgery is a preferred treatment option. Carotid endarterectomy could be used in severe cases to cut the carotid artery and remove the blockage.

Risk Factors of Carotid Artery Disease

Risk factors for carotid artery disease include the following:

• Age: Arteries become less flexible with age, and the risk of carotid artery disease increases.
• Obesity: Obesity and excess weight leads to an excess of fats in the body that increase the risk of carotid artery disease.
• Diabetes: Diabetes affects your fat metabolism and increases the risk of developing carotid artery disease.
• High blood pressure: High blood pressure weakens the walls of the arteries and makes them more prone to injury, increasing the risk of plaque formation.
• Tobacco use: Smoking or tobacco use puts you at a greater risk of developing carotid artery disease.
• Family history: Having a family history of carotid artery disease or atherosclerosis increases your chances of developing carotid artery disease.
• Sedentary lifestyle: Lack of physical activity or exercise leads to an increased risk of carotid artery disease.

Complications of Carotid Artery Disease

Untreated carotid artery disease can lead to the following complications:

• Carotid artery occlusion: An increase in blockage of the artery can lead to complete occlusion.
• Stroke or TIA: Stroke or TIA is a common complication of carotid artery disease due to the reduced blood supply and lack of nutrients to the brain.
• Death: Severe cases of stroke can lead to sudden death.

Carotid Artery Disease Prevention

Primary Prevention of Carotid Artery Disease

The risk of carotid artery disease and associated stoke can be reduced or prevented by the following preventive measures:

• Eating a balanced diet: Eating a balanced diet with a good mix of protein, carbohydrates, and fats is crucial for good metabolism and overall health. Adding fruits, nuts, and leafy vegetables has great effects on vascular health.
• Exercise: You should aim to exercise for at least 30 minutes a day or 150 minutes a week to maintain a healthy heart. Also, get physically active to stay ahead of the disease.
• Regular health check-ups: Regular monitoring of blood pressure and cholesterol levels and getting regular check-ups are crucial to keeping your vascular health and reducing the risk of carotid artery disease.
• Managing stress: Practice yoga, mindfulness, etc. to reduce stress in your life
• Quit smoking: Tobacco use is a major risk factor for carotid artery disease via injury to blood vessels at the microscopic level.

Secondary Prevention of Carotid Artery Disease

Secondary prevention aims to reduce the risk of recurrences or avoid complications post-treatment.

• Symptom watch-out: Always lookout for any signs or symptoms of carotid artery disease and seek immediate medical care if required.
• Lifestyle modifications: Eating a balanced diet, exercising regularly, and getting physically active is crucial for heart health and reducing recurrences.
• Regular health check-up: Regular monitoring of your vitals and visiting the doctor on scheduled follow-ups is crucial for an event-free recovery.

Epidemiology of Carotid Artery Disease

• Carotid artery disease is a leading cause of stroke and associated deaths globally.
• The prevalence of carotid artery disease increases with age and is more common in people aged above 50 years.
• It is more prevalent in men compared to women.
• Carotid artery disease is more prevalent in whites and Native Americans.

Expected Prognosis of Carotid Artery Disease

Carotid artery disease with moderate or severe blockage requires aggressive treatment such as surgery. The chances of survival in long-term follow-up are around ten years post carotid endarterectomy.

Natural Progression of Carotid Artery Disease

Undiagnosed and untreated plaque formation will increase blockage with time and will eventually lead to occlusion of the carotid artery and associated stroke or TIA.

Pathophysiology of Carotid Artery Disease

At the microscopic cellular level, injuries caused by free radicals or weakened artery walls lead to the creation of sites for plaque formation. As the plaque formation starts and deposits increase in volume along the walls of the arteries, atherosclerosis occurs. Atherosclerosis causes arteries to clog and become narrow.