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Carotid artery
atherosclerosis
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- The carotid arteries (common
carotid, internal carotid, and external carotid) provide the
main blood supply to the brain. These may become narrowed
due to cholesterol plaque build up, leading to a condition
known as carotid artery atherosclerosis.
- Should there be significant narrowing of the carotid arteries, or ulcerations in the cholesterol-causing micro-emboli (plaque travels to the brain and blocks off small blood vessels), a Stroke or Transient Ischemic Attack ("mini-Stroke") can
occur.
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- May have none (asymptomatic)
- Signs of Stroke: loss of vision,
weakness (partial or total paralysis), speech difficulties,
or other neurological signs
- Signs of TIA (Transient Ischemic Attack) are the same as signs of Stroke except that they
completely resolve in 24
hours
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- Examination may reveal carotid
bruits (a sound heard by the stethoscope)
- Carotid ultrasound/duplex scans
will make the diagnosis
- An MRA scan (a type of scan
performed with an MRI) can be more accurate and at times
helpful
- Carotid angiograms are used to prepare for surgery, or if diagnosis is not clear (dye is injected into the carotid arteries and X-Rays
taken)
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- Asymptomatic -- occurs when the
doctor, on examination, finds carotid stenosis, but there
are no symptoms. In patients with severe stenosis (>70%
blockage), treatment is still controversial.
- Some medical literature supports doing early surgery to remove the cholesterol blockage using a procedure known as carotid endarterectomy. The procedure itself carries a risk of Stroke (about 2.7%). Overall, as suggested by the studies, the risk of Stroke will be decreased as a
result of these procedures. However, a recent article in the
New England Journal of Medicine suggests that not all
patients with severe carotid artery stenosis may need
surgery (especially in the light of other risk factors).
- Symptomatic -- the patient has had TIAs or Stroke in the distribution
of the carotid stenosis):
- If carotid stenosis is
>70%--surgery (carotid endarterectomy)
- If carotid stenosis is
50-69%--surgery has also been found to be beneficial
- If carotid stenosis is less than 50%--medical management with aspirin or Plavix
- Aspirin or Plavix may be given
after surgery as well
- Cholesterol should be aggressively controlled (diet
and/or
medication)
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- Low cholesterol diet
- Cholesterol lowering medications, especially the "statins" such as Pravachol and Lipitor (may decrease the risk of Stroke by 30%)
- All other risk factors for Stroke should also be
carefully evaluated and treated, e.g., blood pressure should
be controlled, smoking should be discontinued, diabetes
controlled, etc.
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- Both asymptomatic and symptomatic carotid artery disease often are often warning signs for coronary artery disease (cholesterol blockages in the arteries of the heart). Patients with carotid artery atherosclerosis should be carefully evaluated for coronary artery disease.
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