Carotid Artery Stenosis
Carotid artery stenosis is the narrowing of the carotid arteries. These are the main arteries in the neck that supply blood to the brain. Carotid artery stenosis, also called carotid artery disease, is a major risk factor for ischemic stroke. (This is the most common form of stroke and is usually caused by a blood clot plugging an artery.)
The narrowing is usually caused by plaque in a blood vessel. Plaque forms when cholesterol, fat and other substances build up in the inner lining of an artery. This process is called atherosclerosis.
What Are The Signs And Symptoms Of The Condition?
Signs Or Symptoms May Include: -
problems with movement, such as weakness, clumsiness, or paralysis. These are often on only one side of the body. In some cases, people may only have weakness or clumsiness in their hand. In other cases, one entire half of the body becomes paralyzed.
numbness or a lack of feeling, which is also often on only one side of the body
speech impairments, including slurred speech or difficulty finding the correct word
- difficulty doing math or writing
- difficulty understanding speech or writing
- inability to recognize family members or common objects
dementia, a condition that affects memory, understanding, and the ability to carry out the normal activities of daily life
- visual impairment, including blurred vision or total vision loss
- hearing impairment
- personality changes
- difficulty swallowing
- balance problems, known as ataxia
the inability to breathe on one's own. This may require a person to be put on an artificial breathing machine, or ventilator.
How Is Carotid Artery Stenosis Diagnosed?
Carotid artery stenosis may or may not cause symptoms. A doctor may hear an abnormal sound called a bruit (BROO'e) when listening to the artery with a stethoscope. The stenosis can be easily detected with an ultrasound probe placed on the side of the neck near the carotid arteries. This is called carotid ultrasonography.
Another way to diagnose carotid stenosis is by magnetic resonance angiography, a special X-ray test in which pictures are taken of the arteries in the neck. Both these tests are painless and noninvasive.
Cranial MRIs and cranial CT scans may be ordered to show the type, size, and location of the stroke.
Depending on the degree of stenosis and the patient's overall condition, carotid artery stenosis can usually be treated with surgery. The procedure is called carotid endarterectomy. It removes the plaque that caused the carotid artery to narrow. Carotid endarterectomy has proven to benefit patients with arteries stenosed (narrowed) by 70 percent or more. For people with arteries narrowed less than 50 percent, anti-clotting medicine is usually prescribed to reduce the risk of ischemic stroke. Examples of these drugs are antiplatelet agents and anticoagulants.
Carotid angioplasty may be another treatment option. It uses balloons and/or stents to open a narrowed artery.
Most people with strokes are treated right away with only aspirin if they do not have bleeding into the brain. This only serves to help prevent further strokes. In cases when a stroke is caught in the first few hours, a clot-busting medication may be used to reverse a stroke. This is why early recognition of a stroke can be important.
If someone has the early warning signs of stroke, the emergency medical system should be contacted immediately. These signs include a sudden onset of: -
- severe headache
- weakness or numbness of the face, arm, or leg, especially on one side of the body
- trouble walking or loss of balance, known as ataxia
- speech impairments, including trouble speaking or understanding speech
- visual impairments
Other medications that may be used for a stroke from carotid stenosis include medications to lower blood pressure and cholesterol.
What Are The Causes And Risks Of The Condition?
The nonmodifiable factors are ones that cannot be changed by the individual and include: -
- increasing age. A person's risk of stroke doubles each year after age 55.
- race. Strokes occur approximately twice as often in blacks and Hispanics as they do in whites.
- gender. Men have a 50% higher chance of stroke than women do.
- family history of stroke or transient ischemic attack (TIA). A TIA is a short, reversible form of stroke that may serve as an early warning sign of stroke.
Well-documented modifiable risk factors are those that can be changed by the individual in conjunction with his or her healthcare provider. These factors are linked to stroke by strong research findings, and there is documented proof that changing the risk factor lowers a person's risk of stroke.
These factors include:-
- high blood pressure
- asymptomatic carotid stenosis, or narrowing of one of the arteries in the neck
- sickle cell anemia, a blood disorder that forms abnormal red blood cells
- high cholesterol levels in the blood, including total cholesterol and LDL or "bad cholesterol." Low levels of HDL or "good cholesterol" are also cause for concern.
- atrial fibrillation, an abnormal heart rhythm
- sedentary lifestyle
- alcohol abuse
- high blood levels of homocysteine, a blood component sometimes associated with a higher risk of stroke
- drug abuse
- blood disorders, such as blood that clots easily or deficiencies of various blood components
- hormone replacement therapy (HRT). The AHA currently states that the risk of stroke associated with HRT appears low but needs further study.
- use of birth control pills, or oral contraceptives
- inflammatory processes, such as a chronic infection with chlamydia
Several recent studies have identified factors that seem to increase or decrease the risk of stroke in particular groups of people. These studies, which warrant further investigation, include these findings:
- People who were treated for high blood pressure with thiazide diuretics, such as hydrochlorothiazide, had a significantly lower stroke risk than people on ACE inhibitors or calcium channel blockers.
- Women ages 39 to 50 who ate more fish and omega-3 polyunsaturated fatty acids had a reduced risk of stroke. This was particularly true in women who did not take aspirin regularly.
- Women ages 15 to 44 who had 2 drinks of wine a day had a 40% to 60% lower risk of stroke than women who did not drink alcohol.
- Phenylpropanolamine, a compound contained in appetite suppressants and cold remedies, significantly increased the risk of hemorrhagic stroke in women 18 to 49 years of age. The Food and Drug Administration (FDA) has since asked manufacturers to remove phenylpropanolamine from their products.
- In one study, people who were treated in emergency departments for transient ischemic attacks (TIA) had a 25% chance of having a stroke or other serious health event within the next 90 days.
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