Dr Jason Toniolo

Carotid Artery Disease

Carotid artery disease occurs when the carotid arteries in the neck, which supply blood to the brain, become narrowed or blocked due to plaque buildup (atherosclerosis).

This condition increases the risk of stroke, as these plaques can rupture and shower the brain with debris, which blocks the smaller vessels of the brain

Symptoms of carotid artery stroke

A carotid plaque in the neck that isn’t causing a stroke does not cause any symptoms.

The Carotid artery, when causing symptoms, generally leads to either transient strokes (TIA) or permanent strokes. The territory of the brain supplied by the carotid arteries is the front 2/3 of the brain. When this part of the brain is having symptoms, one will generally notice:

  • Sudden weakness, numbness, or difficulty moving one half of the body (any region, face, arms or limbs)
  • Difficulty speaking
  • Vision changes ignoring one-half of the visual field
  • Transient loss of vision, with a black curtain that comes over the eye, then disappears (amaurosis fugax)

What are the risk factors, and how can their progression be modified?

Risk factors for aneurysms include:

  • Age: The risk of aneurysm increases with age.
  • Smoking: One of the most significant modifiable risk factors. Smoking weakens the arterial wall and accelerates aneurysm growth.
  • Hypertension: High blood pressure contributes to the formation and expansion of aneurysms.
  • Atherosclerosis: Plaque build-up in the arteries can weaken the arterial wall.
  • Family History: A genetic predisposition to aneurysms increases risk, particularly in first-degree relatives.
  • Genetic Conditions: Disorders like Marfan syndrome or Ehlers-Danlos syndrome increase the risk of aortic aneurysms.

Modifying progression:

Lifestyle modifications, such as quitting smoking, managing blood pressure and cholesterol, and maintaining a healthy weight, are advantageous for slowing aneurysm growth. Patients with aneurysms should be regularly monitored with imaging, and any rapid growth requires prompt medical attention. Studies are being conducted using doxycycline and metformin to reduce aneurysm growth, but this is not yet prescribed or common practice among vascular surgeons at this stage.

treatment options

Lifestyle changes and medications

Methods to prevent plaque buildup and reduce inflammation in atherosclerotic plaques include

  • Exercise
  • Control blood sugars
  • Control hypertension
  • Use of a statin (known as a cholesterol tablet, its better function and its ability to reduce inflammation in blood vessels)
  • Anti-platelet medications (aspirin / clopidogrel)

Open surgical reconstruction

Carotid endarterectomy is the term used to describe surgery in which the carotid artery is cut open, the plaque is removed, and the artery is repaired with stitches.

This surgery takes under 1.5 hours and is very fast to recover from. Significant risks are involved in the surgery, which should be explained in detail. For someone with a >50% narrowing in their artery who has suffered a transient or permanent stroke, carotid endarterectomy is the standard of care across the world for preventing further strokes.

Minimally invasive carotid artery stenting

Carotid stenting procedures are a valuable tool to deal with the disease in the neck when it isn’t safe to treat surgically with carotid endarterectomy.

There are subtle advantages to a stent, but the disadvantages when compared to open carotid endarterectomy mean that stenting is not the standard of care unless there are some particular criteria that make it a better choice than open surgery.