Carotid (Neck) Artery Disease

What is Carotid Artery Disease?

Carotid Artery Disease is a form of Peripheral Artery Disease that affects blood flow through the carotid arteries, the two large vessels (one on each side of your neck) that supply blood to the brain. When you feel your pulse on your neck under your jaw, you are feeling the movement of the carotid artery as blood flows through it.

Disease in the carotid arteries or the blood vessels in the brain is also known as cerebrovascular disease.

Like your other arteries, the carotid arteries can become narrowed or blocked by hardening of the arteries ( atherosclerosis), the gradual buildup of fatty deposits ( plaque) on the walls of the arteries. Narrowing of the carotid artery is called carotid stenosis.

A: Location of the carotid artery on one side of the neck. B: Close-up of a normal carotid artery. C: Close-up of a diseased carotid artery; the artery is narrowed by atherosclerosis

Narrowed carotid arteries put you at risk for stroke, when blood flow to the brain is blocked, damaging the brain tissue. A stroke can happen in someone with carotid artery disease if:

• The artery becomes severely narrowed
• A fatty deposit in the carotid artery ruptures, triggering the body to produce a blood clot to control the injury. The clot can become lodged in the carotid artery or one of the smaller arteries in the brain, cutting off blood flow
• A piece of the fatty plaque lining the carotid artery breaks off and becomes lodged in a smaller blood vessel in the brain.

The more severe your carotid artery disease is, the more likely you are to have a stroke. Stroke is the number three cause of death in the United States, and the number one cause of long-term disability. If you have carotid artery disease, proper treatment can slow the progression of the disease and prevent a stroke.

What causes carotid artery disease?

In most cases, carotid artery disease develops gradually over time due to the buildup of fatty deposits on the walls of the arteries (atherosclerosis). This is the same disease process that causes coronary artery disease when it happens in the arteries that supply blood to the heart, and peripheral artery disease when it blocks blood vessels elsewhere in your body, such as the legs.

Less common causes of carotid artery disease include:

• fibromuscular dysplasia (FMD) - a genetic disease in which the cells in the walls of the arteries grow abnormally
• aneurysms - weakening of the artery wall which causes it to bulge out and eventually rupture
• dissection a traumatic tearing of the inner lining of the carotid artery
• some rare disorders of the artery lining

What are the symptoms of carotid artery disease?

Because carotid artery disease causes no symptoms in the early stages, it often goes unnoticed by the patient and her doctor until it becomes severe enough to disrupt blood flow to the brain. It is important to see your doctor for regular examinations, as she or he can use a stethoscope to detect some blood flow problems in the neck before they cause serious complications.

Unfortunately, the first symptom of carotid artery disease is often a stroke or TIA (transient ischemic attack). A TIA, also known as a " mini-stroke," happens when there is a short-term reduction in blood flow to the brain. If you have any of these symptoms

• Sudden numbness or weakness of face, arm, or leg, especially on only one side of the body
• Sudden confusion or trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or loss of balance or coordination
• Sudden severe headache with no known cause

Stroke symptoms that go away quickly after a short time is known as a TIA (transient ischemic attack), a warning sign that a full-fledged stroke may happen soon. One in 10 women who have a TIA will have a stroke within 90 days.  If you experience any of the above symptoms, even if they go away after a short time, you need to get treatment to prevent a full stroke.

See Signs of Stroke to learn more about how to recognize the symptoms of a stroke or TIA. See Stroke Diagnosis Overview to learn what tests are used to determine if you've had a stroke or TIA.

Who is at risk for carotid artery disease?

In the general population, 7% of women aged 65 or older have carotid arteries that are more than 50% blocked by atherosclerosis. The risk of carotid artery disease increases as you get older. Only 1 in 25 women aged 65 to 69 have significant blockages, while 1 in 10 women older than 80 have them.

You are at higher risk for carotid artery disease if you have certain characteristics or conditions (called risk factors). The more risk factors you have, the more likely you are to develop the disease. The risk factors for carotid artery disease are similar to those for other types of heart and blood vessel disease, including coronary artery disease. Some of these factors are out of your control, such as:

• your age and menopausal status carotid artery disease is more common the older you get, and is more common after menopause
• your family history  you're more likely to have the disease if a close relative has developed any form of artery disease
• your race or ethnicity c arotid artery disease is more common in African Americans compared with whites

Other risk factors are related to an unhealthy lifestyle that you can change to reduce your risk, including:

• High blood pressure
• Eating an unhealthy diet, high in saturated fats and cholesterol
• Lack of exercise
• Being overweight
• High cholesterol
• Smoking

You are at especially high risk of developing carotid artery disease if you already have atherosclerosis in your other arteries, such as coronary artery disease or peripheral artery disease (PAD) in your legs, or if you have suffered a heart attack or stroke in the past.

Orthostatic hypotension

Orthostatic hypotension, also known as postural hypotension, and colloquially as head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching. The symptom is caused by blood pooling in the lower extremities upon a change in body position. It is quite common and can occur briefly in anyone, although it is particularly prevalent among the elderly, and those with low blood pressure. It can also cause people to be dizzy on the spot.

What is a stroke?

A stroke occurs when vital blood flow and oxygen to the brain is interrupted. When blood flow to the heart is blocked, it's called a heart attack; similarly, a stroke is sometimes called a "brain attack." A stroke can injure the brain just as a heart attack can injure the heart. Another name that doctors often use for stroke is cerebrovascular accident CVA.
 

There are two types of stroke:

• Ischemic stroke is the most common type of stroke. It occurs when there is a sudden lack of blood flow to some part of the brain, usually due to a blood clot blocking an artery or a blood vessel in the brain. Often the artery is already clogged with plaque and fatty deposits ( atherosclerosis).


• Hemorrhagic stroke, or bleeding in the brain, is caused by a broken or leaking blood vessel in the brain. A bleeding (hemorrhagic) stroke may be due to an aneurysma thin or weak spot in an artery that balloons out and can burst.

Approximately 9 out of every 10 strokes are blocked-vessel (ischemic) strokes; the rest are bleeding (hemorrhagic) strokes. Both types of stroke cause brain cells to die. Two million brain cells die every minute during a stroke, increasing the risk of permanent brain damage, disability, or death. This brain damage may cause you to lose control of certain functions, such as speech, movement, and memory.