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Dr. Craig Walker listens to a patient's carotid artery with a stethoscope

What is Carotid Artery Disease?

Carotid artery disease (CAD) occurs when fatty deposits, or plaque, builds up within the inner walls of these arteries leading to partial or complete blockages. CAD progresses slowly and can often go undiagnosed for a long period of time. The consequences can be life-threatening.

Risk Factors Associated with Carotid Artery Disease

Some people are considered to have a higher risk of developing CAD than others. Unsurprisingly, many of these factors are the same as those that contribute to other forms of cardiovascular disease as well. They include:

  • Smoking
  • Family history of cardiovascular disease
  • High cholesterol
  • Diabetes
  • Obesity
  • High blood pressure (hypertension)
  • Sleep apnea
  • Lack of physical fitness

Complications of CAD

The primary concern related to CAD is the risk of stroke. A stroke occurs when blood flow to the brain is interrupted. The severity of a stroke depends on the specific area of the brain affected and the number of brain cells impacted. There are two specific types of stroke which may result from CAD:

  • Ischemic – Ischemic stroke occurs when there is a blockage of a blood vessel which supplies the brain. This type of stroke is divided into two categories: embolic and thrombotic. Embolic strokes occur when a blood clot travels from another area of the body, such as the heart, to the brain where it creates a blockage. Thrombotic strokes are the result of blockages that originate within the arteries supplying blood to the brain.
  • Transient Ischemic Attack (TIA) – TIA is a “mini stroke” in which blood flow to the brain stops for only a brief period of time. While it can cause the same symptoms as a regular stroke, TIA symptoms typically last less than 24 hours. They also do not typically lead to permanent brain damage. However, for many, experiencing a TIA is the first warning sign of CAD they may experience.

How is Carotid Artery Disease Diagnosed?

The first step in reaching a diagnosis of CAD is a physical examination by a cardiologist. The physician will assess for risk factors and use a stethoscope to listen to the carotid arteries. Following the exam, additional testing will be needed before a definitive diagnosis can be reached. Common diagnostic tests for CAD include:

  • Ultrasound – Specifically, a carotid duplex ultrasound may be used to assess blood flow and pressure within the carotid arteries.
  • CT Scan – A CT scan takes a series of x-ray images and uses them to produce 3D images of the brain on a computer. This test is often used when a TIA or stroke is thought to have occurred.
  • Carotid Angiogram – A catheter is started in the arm or leg and guided to the carotid artery. Dye is injected through the catheter and a special x-ray machine is used to produce images.
  • Magnetic Resonance Angiogram (MRA) – MRA is a specific type of MRI which combines radio waves and a magnetic field to produce pictures of the carotid arteries.
  • Computed Tomography Angiogram (CTA) – CTA combines the technology of a CT scan with intravenous contrast dye to produce highly detailed 3D images of the carotid arteries.

How is CAD Treated?

Mild to Moderate CAD

If CAD is diagnosed but believed to be mild to moderate in nature, more conservative treatment methods may be used to prevent worsening of the condition.

These can include quitting smoking, losing weight, eating a heart healthy diet, and exercising regularly.

Additionally, a drug regimen of blood thinners or Aspirin may be prescribed. Follow-up care to monitor CAD will also be an imperative part of treatment.

Severe CAD

For more severe cases of CAD or for those in which a TIA has already occurred, more aggressive treatment methods will be employed. Common procedures to address CAD include:

  • Carotid Endarterectomy – During the procedure, the surgeon makes an incision at the site of the carotid artery. The plaque buildup is removed and the vessel is stitched closed. This is the most commonly used treatment for CAD and has been proven very effective in treating both symptomatic and asymptomatic cases in which the blockage is at least 50 percent.
  • Carotid Angioplasty and Stenting – This minimally-invasive option involves the use of a balloon catheter and a special type of filter called an embolic protection device. As the balloon is inflated to widen the artery, the filter captures any part of the blockage that may break away. Then, a mesh stent is placed in the widened artery and left to support it and keep it open.
  • Transcarotid Artery Revascularization (TCAR)- This minimally-invasive procedure is designed to treat carotid artery disease while minimizing the risk of stroke. Unlike traditional carotid endarterectomy, which requires a larger incision, TCAR involves a smaller incision just above the clavicle. During the procedure, blood flow is temporarily redirected away from the brain to prevent debris from causing harm. A stent is then placed in the carotid artery to stabilize plaque and reduce the risk of future strokes. With a 50% lower stroke risk compared to stenting through the groin, TCAR offers a quicker recovery, less pain and smaller scars.

Conditions Related to Cardiovascular Disease

A close up shot of several EKG leads hanging

Chronic Total Occlusion
A doctor in a PPE gown examines a CT scan of a heart for Coronary Artery Disease

Coronary Artery Disease
CIS staff members preforming a procedure on a patient with heart failure in an operating room

Heart Failure
A nurse prepares blood samples to check for lipid disorders

Lipid Disorders

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CIS physicians have pioneered the use of carotid angioplasty and stenting to treat carotid artery disease. Our physicians evaluate each patient on a case-by case basis to determine the best course of treatment.

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