Home › Forums › Other Specialities › General Topics › CAROTID ARTERY DISEASE- PT INFO.PART 1.
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December 21, 2023 at 1:44 pm #1834
Anonymous
InactiveCarotid artery disease
Most strokes happen because of a blockage in an artery. A common cause of this is disease in the large carotid arteries in the front of your neck.This factsheet explains how carotid artery disease develops, how it is diagnosed and how it may be treated.
What is a stroke?
A stroke is a brain attack which happens when the blood supply to the brain is cut off.
A transient ischaemic attack (TIA) is like a stroke but the symptoms disappear within 24 hours. A TIA is sometimes a warning sign that a stroke may follow.Around 20 per cent of all strokes are caused by carotid artery disease. This is more common in older people who have a stroke.
What is carotid artery disease?
At the front of your neck are two large blood vessels, called the carotid arteries, which carry the majority of your blood supply to your brain. There are another two large arteries that run alongside your spine and up the back of your neck called the vertebral arteries. These four arteries join together in a rough, circular shape called the circle of Willis. From here, your arteries separate into smaller arteries, and then smaller arteries still. Blood travels along these arteries until it reaches all parts of your brain.Carotid artery disease is the name for the narrowing of one or both of the carotid arteries. The medical term for the narrowing of an artery is stenosis. When we are young our arteries are wide and flexible, but as we get older our artery walls become thicker and less flexible.
A harmful build-up of fatty deposits (yellow patches called ‘atheroma’ or ‘plaque’) can develop on the inside walls of our arteries. Over time, these arteries can become more and more ‘furred up’ with plaque, reducing the blood flow through them.
The medical term used to describe the hardening and thickening of the large arteries within our bodies is atherosclerosis.Why does carotid artery disease develop?
We all develop some narrowing in our arteries, including our carotid arteries, especially as we get older. However, for some people this is more severe than others. Being male, of an older age, and having a family history of stroke or angina are some of the risk factors for carotid artery disease.While there is nothing that can be done to change these, other risk factors can be controlled.
They include:
• high cholesterol
• high blood pressure
• diabetes
• smoking
• lack of exercise
• being overweight.How can carotid artery disease cause a stroke or TIA?
1. Total occlusion This is the medical term for when plaque narrows and completely blocks a carotid
artery, cutting off the blood supply to the brain and causing a stroke.If one of your carotid arteries becomes narrow or blocked, the circle of Willis may compensate, allowing blood from other
arteries to supply enough blood to all parts of your brain. However, the circle of Willis-(see above), is only intact in about 35 to 50 per cent of people. For the rest of the population the circle of Willis does not form a true circle and cannot compensate.2. Thrombosis
As well as making our arteries narrower, atherosclerosis can make the inner surface of our artery walls fragile and likely to break up. Where this happens, the lining of the artery becomes exposed and blood begins to clot over it. The clot that forms here can then cause a blockage in the artery, cutting off the blood supply at this point. This clot is called a thrombosis.3. Embolism
A blockage in your blood vessel, caused by something that has travelled in your bloodstream from elsewhere in the body, is
known as an embolism. It is possible for a clot to form, then break away and travel in your bloodstream causing a blockage somewhere else. In the arteries in your neck, blockages tend to happen at points where the arteries branch into two smaller arteries.It is also possible for a piece of plaque to break away and travel in your bloodstream, causing a blockage somewhere else. This is most likely to happen with a plaque that is unstable (one with a thin crust with a large amount of soft, fatty deposit underneath). More research is needed to find out why unstable plaques develop and how best we can prevent and treat them.
How is carotid artery disease diagnosed?
Carotid artery disease is usually diagnosed when you have the symptoms of a TIA or a stroke. Occasionally, a doctor might
discover that you have some narrowing if you are having tests on these arteries for another health reason. Your doctor may listen to the sound of your blood flow through your carotid arteries using a stethoscope. If it sounds unusual it might indicate that there is some narrowing. You will then be referred to a hospital specialist for further tests.The main test is called an ultrasound (or a Carotid Doppler). It is a completely painless procedure. A small probe is passed over the side of your neck to build up a picture of your arteries. The specialist can then see whether there is any narrowing and, if so, whether it is severe enough to benefit from having an operation.
You will probably have further tests to confirm this diagnosis. These may involve having a special dye injected into your arteries. This is called angiography or arteriography and makes your arteries visible when scanned, for example, by x-ray.
In the UK, the NASCET scale (North American Symptomatic Carotid Endarterectomy Trial) is usually used to measure carotid stenosis. This has two categories of measurement which are:
• moderate – less than 69 per cent blocked
• severe – 70 to 99 per cent blocked.How can it be treated?
There are procedures that can be done to reduce the risk of a further stroke or TIA, but they will only be offered to you if your
artery has severe stenosis. This is because the procedures themselves carry risks. The main procedure is an operation called
carotid endarterectomy.. Stent placement can also be considered.- SEE PART 2 for more.If your artery is completely blocked there remains a small risk of stroke.
Part 2 follows.
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