Neck Carotid Artery Disease: What to know and what to look out for

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by - By Dr. Benjamin Zussman, neurosurgeon at Wellstar North Fulton Medical Center

This Stroke Awareness Month, learn the signs and causes of a stroke so you can take action right away if you or someone else experiences one. The Neuro Care team at Wellstar works with patients to reduce their risk of a stroke and provide lifesaving care in the event of a stroke.

The carotid artery is a major blood vessel that brings blood from your heart to your brain. There are normally two carotid arteries, one on the right side and one on the left. At the point where the carotid artery divides into a branch that feeds the face and a branch that feeds the brain, there is a natural location for the buildup of debris, called atherosclerotic plaque.

As plaque buildup increases, it takes up more space within the vessel and begins to narrow the path for blood flow through the vessel. This narrowing is called stenosis. Because plaque buildup is typically disorganized, bits of plaque can tear off or rupture. When a plaque ruptures, it may cause a stroke.

Patients with plaque buildup who develop stroke-like symptoms, or an actual stroke are referred to as having “symptomatic” disease, because the plaque is believed to have caused their symptoms.

In contrast, patients with plaque buildup who have never had symptoms before are referred to as patients with “asymptomatic” disease. Patients with asymptomatic disease may be identified during a physical examination when a “whooshing” sound or bruit is heard over the carotid artery or when an imaging study of their neck is done for another reason. In general, the worse the carotid stenosis, the higher the chance of a stroke.

If you know that you have carotid artery stenosis, then you should watch out for the signs and symptoms of a stroke. One easy way to remember the classic stroke symptoms is to BE FAST:

• Balance — One sign is a sudden loss of balance or coordination. This can also appear as a sudden, severe headache or dizziness.

• Eyes — Blurred vision, double vision or loss of vision can be symptoms of a stroke. If you think someone else may be having a stroke, ask if they are having trouble seeing out of one or both eyes.

• Face — One side of the face may be drooping or feeling numb. Ask the person to smile and see if it appears lopsided or uneven.

• Arms — Look for sudden arm weakness or numbness. Check if the person can lift both arms without one drifting downward.

• Speech — Check for slurred speech or difficulty speaking. Ask the person to repeat a simple sentence to determine if they are having trouble talking.

• Time — The more treatment is delayed, the more the brain is damaged. Don’t wait to seek care. If you notice any of these symptoms, call 911 immediately.

For patients with mild carotid artery disease, there are several effective strategies to reduce the risk of a stroke. High cholesterol contributes to carotid plaque formation, and providers may prescribe medications to lower the body’s cholesterol level. Carotid stenosis narrows the path for blood flow, so other medications are used to keep blood flowing smoothly around the plaque. Finally, quitting cigarette smoking improves the body’s natural repair mechanisms, since smoking limits the body’s ability to heal vessel walls.

For patients with severe carotid disease, there are different procedures to reduce the risk of a stroke. In carotid endarterectomy, the provider will make a two-inch neck incision to expose the carotid artery. First, the artery is temporarily clamped to prevent bleeding. Then, the artery is opened and cleaned to completely remove the plaque. Finally, the artery is sewn, and the incision is closed.

In carotid artery stenting, a small tube or catheter is inserted through the wrist or the leg and steered within the body’s vessels to the carotid artery. First, a protection device is positioned to catch any debris that may become dislodged. Then, a metallic tube called a stent is expanded to push the plaque to the side and widen the artery. Finally, the machinery is removed, and the entry sites are closed.

The neurosurgeons at Wellstar North Fulton Medical Center have extensive training and experience in the treatment of carotid artery disorders. The hospital is recognized as a Certified Advanced Comprehensive Stroke Center — the highest level of stroke certification available — by The Joint Commission. Our dedicated neurocritical care and vascular neurology teams provide worldclass care for patients before and after they undergo a carotid artery procedure.

To make an appointment with a neurosurgeon on the campus of Wellstar North Fulton Medical Center, call (770) 664-9600.