Carotid Artery Disease & Stroke Treatment
Carotid Artery Disease (also called Carotid Artery Stenosis) is the narrowing of the arteries from fatty buildup, which usually consists of deposits of cholesterol, called plaque. When the artery is completely blocked, this is called carotid artery occlusion. The carotid arteries can also develop atherosclerosis (“hardening of the arteries”). When the deposits of cholesterol build up, it causes narrowing of the arteries. This blockage of the carotid arteries decreases the flow of blood to the brain and has serious risks, including stroke.
Risk Factors
- Smoking
- High blood pressure
- High cholesterol
- Diabetes
- Obesity
- Sedentary lifestyle
- Family history
Symptoms
Carotid artery disease usually does not show symptoms until it causes a transient ischemic attack (TIA) or a stroke.
Diagnosis
Because carotid artery disease does not normally show symptoms, regular physical exams are important. The physician may listen to your carotid arteries to listen for abnormal flow, called a bruit. If your physician suspects possible carotid artery disease, he/she may order medical imaging to make an accurate diagnosis, which may include Carotid Ultrasound, Magnetic Resonance Angiography (MRA), Computerized Tomography Angiography (CTA), or Cerebral Angiography. Carotid Ultrasound, MRA, and CTA are all non-invasive procedures which create a picture of your arteries for the physician to evaluate.
Cerebral Angiogram
Cerebral Angiogram (also called an arteriogram) is a minimally-invasive procedure which allows the physician to get very detailed x-rays of your arteries in real-time to view the blood flow in your arteries.
How to Prepare for a Cerebral Angiogram
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have, especially if you have an allergy to contrast dye or latex.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- You may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After a Cerebral Angiogram
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a catheter into the femoral artery near the groin.
- Contrast material, a clear fluid that is visible on x-ray imaging, is injected through the catheter to produce an image of the blood vessels. This fluid may cause a warm sensation for a moment.
- X-rays are taken and you may be asked to hold very still so that the images come out clearly.
- After the procedure, the catheter is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- The procedure lasts about 1-2 hours.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- Your physician’s staff will schedule a follow-up clinic appointment for you. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Treatment
A few procedures are available to treat carotid artery disease: Endarterectomy, Balloon Angioplasty (with or without Carotid Artery Stenting) and Atherectomy. Endarterectomy is a procedure used for severe blockage of the arteries, which requires open surgery. Balloon Angioplasty with or without Carotid Artery Stenting and Atherectomy are minimally-invasive procedures performed by an Interventional Radiologist.
Balloon Angioplasty with or without Carotid Artery Stenting
Balloon Angioplasty with or without Carotid Artery Stenting is a minimally invasive procedure that is suitable for many patients, especially for those who are not good candidates for an invasive surgery. Balloon Angioplasty is done by inserting a special catheter with a balloon at the tip into the artery using medical imaging for guidance. Once the catheter is in position, the physician inflates a balloon to push the plaque buildup against the artery wall. This process opens the artery and restores better blood flow. If stenting is to be performed, the physician will insert a compressed stent into the artery. Once it is in place, the physician will expand it to fit properly in the artery. The stent reinforces the artery wall and allows blood to flow through.
How to Prepare for Balloon Angioplasty with or without Carotid Artery Stenting
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have, especially if you have an allergy to contrast dye or latex.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- You may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After Balloon Angioplasty with or without Carotid Artery Stenting
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a catheter into the femoral artery near the groin.
- Contrast material, a clear fluid that is visible on x-ray imaging, is injected through the catheter to produce an image of the blood vessels. This fluid may cause a warm sensation for a moment.
- X-rays are taken and you may be asked to hold very still so that the images come out clearly.
- The physician will guide the balloon catheter to the site of the blockage and expand the balloon.
- If a stent is being placed, the physician will insert a compressed stent and guide it to the site and expand it to fit properly in the artery.
- After the procedure, the catheter is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- The procedure lasts about 1-2 hours.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- This procedure may require a 1-3 night stay in the hospital.
- Your physician’s staff will schedule a follow-up clinic appointment for you. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Atherectomy
Atherectomy is a minimally-invasive procedure which clears plaque buildup and blockages from your arteries. The physician uses a special catheter with a crown, which sands away the buildup from the artery to restore blood flow to the diseased artery. Angioplasty and/or stenting may follow the Arthrectomy to widen the artery.
How to Prepare for Atherectomy
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have, especially if you have an allergy to contrast dye or latex.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- You may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After Atherectomy
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a catheter into the femoral artery near the groin.
- The physician will guide the catheter to the site of the blockage using medical imaging and carefully sand away the buildup.
- If Angioplasty and/or Stenting is required, the physician will perform that procedure.
- After the procedure, the catheter is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- The procedure lasts about 1-3 hours.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- This procedure may require a 1-3 night stay in the hospital.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- Your physician’s staff will schedule a follow-up clinic appointment for you. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Risks
Please discuss the potential risks with your physician before your procedure.
- Clot formation
- Artery Perforation
- Abrupt blood vessel closure
- Dissection, or splitting open of blood vessel
- Heart attack
Benefits
- This minimally invasive procedure requires much less recovery time and pain compared to traditional open surgery.
- May be performed under conscious sedation or general anesthesia
- Only a small nick in the skin is made, which does not require sutures
- It is a very safe procedure with low complication rates
- Requires only a very short hospital stay
- Patients resume most of their normal activities within a few days
Stroke
Stroke is a medical emergency and you should call 911 at the first sign of a stroke, because time is brain. The more quickly a stroke is treated, the better the recovery rate and the lower the risk of brain damage. When a blood vessel to the brain is deprived of oxygen and nutrients because it is blocked by a clot or it bursts, a stroke occurs. When the brain is deprived of oxygen, brain cells die and affect the part of the body which that section of the brain controls by causing paralysis, vision problems, and decreased language and motor skills.
There are two types of stroke, Ischemic and Hemorrhagic, and also Transient Ischemic Attacks (TIAs), often referred to as “Mini-Strokes”.
Ischemic Stroke: This is the most common type of stroke and is caused by a blood clot in the artery, which blocks blood flow to the brain.
Hemorrhagic Stroke: This is caused when a blood vessel ruptures, which deprives the brain of blood.
Transient Ischemic Attack (TIA): TIAs are brief and cause stroke-like symptoms that last only a few minutes to a few hours. Those who experience a TIA are like to have another one and may have an Ischemic or Hemorrhagic stroke if left untreated. TIAs are an early sign of stroke and should be taken seriously and treated immediately.
Prevalence
- Stroke is the third leading cause of death in America
- A stroke occurs every 45 seconds and someone dies from a stroke every three minutes
Risk Factors
- Obesity
- High blood pressure
- High cholesterol
- Smoking
- Family history
- Sickle cell anemia
Symptoms
- Sudden weakness or numbness in the face, arm and/or leg (especially on one side of the body)
- Sudden confusion or difficulty speaking or understanding speech
- Sudden difficulty seeing in one or both eyes (double vision, blurred vision, or partial blindness)
- Sudden severe headache for no apparent reason
- Dizziness, difficulty walking, loss of balance or coordination
To recognize the symptoms of a stroke, remember to act FAST!
Face
- Uneven smile
- Facial droop or numbness
- Vision disturbance
Arm & Leg
- Weakness
- Numbness
- Difficulty walking
Speech
- Slurred
- Inappropriate words
- Mute
Time
- Time is critical
- Call 911 immediately
Download this convenient wallet card reminder to act FAST (includes a place for your emergency contact information).
Click the image above to download & print your FAST card.
Diagnosis
To determine if a patient is having or is at risk for a stroke, physicians may use one or more of several ways to make a diagnosis.
Computed Tomography (CT)
The first test to diagnose stroke is a CT scan, which provides physicians with detailed pictures of the brain. From these images, a physician can see what kind of stroke is occurring and what part of the brain is affected.
Magnetic Resonance Imaging (MRI)
To gather more detailed information and imaging of the stroke, the physician may perform an MRI. This imaging will help in identifying the area that is deprived of sufficient blood flow.
Angiography
This diagnostic procedure gives the most detailed imaging using real-time x-ray to pinpoint the exact location of bleeding or blockage.
How to Prepare for an Angiogram
Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.
- Be sure to tell your doctor about all medications you are taking and any allergies you may have, especially if you have an allergy to contrast dye or latex.
- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.
- You may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.
- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.
- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.
- Shower or bathe the night before your procedure.
- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:
- Eye Glasses
- Dentures
- Hearing Aid(s)
- You should plan to have a relative or friend drive you home following your procedure.
What to Expect During & After an Angiogram
- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.
- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.
- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.
- A very small nick in the skin is made where the physician inserts a catheter into the femoral artery near the groin.
- Contrast material, a clear fluid that is visible on x-ray imaging, is injected through the catheter to produce an image of the blood vessels. This fluid may cause a warm sensation for a moment.
- X-rays are taken and you may be asked to hold very still so that the images come out clearly.
- After the procedure, the catheter is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).
- The procedure lasts about 1-2 hours.
- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.
- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.
- Your physician’s staff will schedule a follow-up clinic appointment for you. The physician will review the imaging and discuss the results of the procedure with you at this appointment.
Treatment
Coming Soon.