Knowing Carotid Artery Problems
 Carotid Artery Narrowing (Stenosis)  Risk of Stroke  Carotid Artery Surgery (Endarterectomy)  Carotid Artery Stenting
What are the Carotid Arteries?
Your heart pumps oxygen and nutrient rich blood to the rest of the body, including the
brain. The brain depends on a steady supply of blood to function properly. If the brain
does not receive its oxygen and nutrients, affected areas of the brain may be damaged,
which can disrupt body function. Problems with the vessels that supply blood to the brain
can block blood flow and greatly damage the brain.
Blood vessels called arteries carry blood from the heart to the body. The carotid arteries
are the major arteries in your neck that supply your brain with blood. The common
carotid arteries are located on both sides of the neck, and both divide into two branches.
The internal carotid artery brings blood to the brain while the external carotid artery
brings blood to the face and scalp.
Healthy carotid arteries have smooth walls and are unobstructed, enabling blood to flow
easily to the brain. They provide the brain with enough blood to function properly.
What causes a damaged artery?
A damaged artery no longer has a smooth lining, but rather a
substance called plaque accumulates along its walls, so called
“hardening of the arteries”. Plaque is formed when cholesterol and
other particles in the blood stick to the artery wall. The buildup of
plaque causes the artery to narrow, called stenosis. Stenosis
reduces the blood flow to the brain. Artery damage can be caused
by smoking, diabetes and high blood pressure. It also may be
hereditary.
Healthy Carotid Artery
Damaged Carotid Artery
How does a stroke occur? How does it affect you?
The buildup of plaque causes the artery’s wall to be rough allowing blood to collect and form clots. The plaque can rupture
causing pieces to break off and enter the blood stream. The rupture can also cause more blood clots to form. These
plaque fragments and blood clots (emboli) can travel toward the brain and block arteries. This will prevent blood from
reaching parts of the brain, resulting in a stroke.
When a stroke occurs, blood flow is cut off which causes brain tissue to die and therefore, loss of brain function.
Symptoms include difficulty in speaking or controlled movement, but exact symptoms depend on which part of the brain
was damaged. Symptoms often occur only on the side of the body opposite of the blocked artery, not on both sides of the
body. A stroke can cause serious, permanent damage.
What is a TIA?
A TIA (transient ischemic attack) is sometimes called a “mini-stroke” because it is a short episode of strokelike
symptoms. The symptoms are the same as a stroke but go away in 24 hours and do not cause permament brain damage.
Symptoms of Stroke and TIA
If you have these symptoms, get help right away. The longer you wait for medical help; the more damage
the stroke can cause you. Call 911 right away if you are experiencing any of these symptoms.
 Paralysis or weakness on one side of the body
 Difficulty speaking
 Numbness or tingling on one side of the body
 Loss of vision in one eye
 Drooping of one side of the face
What tests will I need?
In order to correctly assess the severity of your carotid artery stenosis and determine treatment options, your doctor will
need to perform an evaluation. You evaluation will include a medical history, exam and ultrasound imaging. Other imaging
tests may be completed as well.
Duplex Ultrasonography:
An ultrasonography or ultrasound is a noninvasive test that uses harmless sound waves to create images of your
body. To improve the image’s accuracy, a gel is applied to the skin. The ultrasonography will look for stenosis in
the carotid arteries. The results can determine the severity of your carotid artery problems and whether or not you
need treatment.
Other imaging tests:
 CTA (computed tomography): A series of x-rays are taken in the form of slices of the brain. Computers use
these images to create 3-D images.
 MRA (Magnetic resonance angiography): This test uses a magnet to create detailed images of the body.
 Angiography: A catheter is inserted into the artery of the groin. A contrast fluid is injected via the catheter
into the carotid artery and x-ray images are taken.
Treatment Options
Treatment will be determined depending on the severity of your stenosis and whether you have experienced stroke
symptoms. Your doctor may advise having a surgical procedure. Two procedures are performed to treat carotid artery
stenosis. One is carotid endarterectomy and the other is carotid artery stenting. Factors such as overall health, your
past medical history, degree of narrowing, and your anatomy will determine which procedure is a better option for you.
Your doctor will suggest a procedure after reviewing these factors.
Carotid Endarterectomy
Endarterectomy is the removal of plaque from the carotid artery using a small incision in skin covering the artery. The
artery is opened and the plaque is removed. The incisions in the artery and skin are closed. There is a low risk of stroke or
complications. Surgery usually takes 2-3 hours: you are then monitored in the recovery room or ICU overnight and
discharged in 1 or 2 days from the hospital. The recovery is often quick with little pain.
The Surgical Procedure:
1. Making the skin incision. Your surgeon will
make an incision on the neck over the carotid
artery.
2. Opening the artery. Your surgeon will place
clamps on the artery above and below the
narrowing. This will prevent blood blow and
allow the surgeon to make an incision in the
artery.
3. Place a shunt. A shunt is usually used to
preserve blood flow to the brain. After the shunt
is in place, the clamps are removed. A shunt
may not be needed in cases where enough blood is reaching the brain via different arteries.
4. Removing the plaque. Your surgeon will loosen plaque from the artery wall and then remove it.
5. Close incision. Your surgeon will then close the incision using
a patch. The clamps are removed and a tube (drain)
may be put in place to prevent fluids from collecting around the area.
Carotid Artery Stenting
Stenting is placing a wire mesh tube (stent) in the artery to keep it open. Stenting is indicated for patients at high risk of
surgery, with previous irradiation to the neck, with prior surgery of the neck and with prior nerve injury. During the surgical
procedure, a long, thin tube called a catheter places the stent in the artery. This procedure uses a local anesthetic. Your
doctor will need to speak with you during the procedure so you will be awake.
Inserting the Catheter:
The doctor will insert a catheter in the groin to prepare for stenting.
 A local anesthetic will numb the area of insertion. A puncture is made in the femoral artery which is a major artery
in the groin.
 An introducing sheath (tube) is then inserted into the puncture. The sheath stays in place during the surgery.
 The catheter is inserted into the sheath. The doctor moves the catheter up the aorta, behind the heart and to the
carotid using x-rays as a guide.
 An angiogram of the carotid artery is taken.
The Stent
A carotid artery stent is a flexible wire mesh tube. The tube may be the same width throughout or
tapered. Once it is place in the artery, it will remain there. The artery stent is most often designed to
resist pressure and crushing. This allows it to adjust when you move your head and neck.
The Procedure
1. Placing the filter. The filter will catch fragments of plaque that may break off and prevent them from
flowing into the brain and casing a stroke. The catheter places the filter in the artery and moves it past
the stenosis. The filter is then opened and stays in place during the procedure. The narrowing is
severe; the artery may need to be widened before the filter
is in place.
2. Opening the artery. A tiny balloon is used to expand the
artery, this is called balloon angioplasty. The uninflated
balloon is moved to the area that needs to be widened. The
balloon is inflated and opens the area inside the artery.
After, the balloon is deflated and removed.
3. Placing the stent. The stent is placed at the area of the
plaque buildup. When it is released, the stent expands until
it touches the surface of the plaque. Balloon angioplasty is
used to fully expand the stent and widen the artery. When
the balloon is withdrawn, the sent is in place to keep the
artery open.
4. Finishing up. An angiogram is taken and compared to the one taken at the beginning of the
procedure to check the success of the stent. Once your doctor is satisfied, the filter and other
instruments are removed. The incision at the groin is closed.
Your Recovery
You will be seen by a visiting nurse daily for the first five days after discharge from the hospital to monitor your progress. If
the nurse does not show, please call our office.
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Take your medications as prescribed.
No driving until your follow up appointment.
Do not shave the area of the incision until your follow up appointment.
You may shower when you go home but only let the water run down the incision. Do not scrub the area! No baths.
The tapes on your incisions should fall off in in 1-2 weeks.
Keep your incision protected/ covered from the sun for 3-4 weeks after surgery then use 20 SPF or higher for six
months.
When to call your doctor (781-729-2020):
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If you have a temperature over 100.5 F.
If you have stroke symptoms, call 911 if there is no response from the office within 5 minutes.
If you note confusion or a severe headache not relieved by Tylenol.
If you have chest pains, shortness of breath or difficulty breathing. Call 911?
If you have swelling, redness, warmth or pain over the incision site.
If you do not have a bowel movement for two days after discharge from the hospital.
If the visiting nurse does not arrive the day after discharge.