Carotid Artery Disease, TIA, and Strokes

Carotid artery disease is when the two main carotid arteries that lead to the brain are blocked. When arterial occlusion occurs, it deprives the brain of oxygen. Factors that increase your risk for carotid artery disease include having PAD (Peripheral Arterial Disease) as well as other comorbidities. When Dr. Nabi screens patients for PAD, he can also check the health of the carotid arteries to assess the risk of stroke.

Early interventions like screenings are paramount to minimizing the chances of a stroke and TIA (transient ischemic attack). An initial screening for carotid artery disease is crucial because many patients can be asymptomatic until an emergent situation, like a TIA or a stroke, occurs.

These grave emergent situations can result when the clogged buildup breaks off, depending on the clot size and where the blockage is situated. This deprivation of oxygen can lead to a TIA or sudden stroke. A TIA is when oxygen is deprived, usually for a short duration. According to Stroke.org, “While a TIA does not cause permanent damage, it is a ‘warning stroke’ signaling a possible full-blown stroke ahead.”

A stroke on the other hand can cause unending damage and even death. Stroke or TIA symptoms include:

• trouble walking

• trouble speaking

• paralysis or numbness, typically on one side of the face or body

• blurred vision

• severe headache

• confusion

If any of these symptoms occur, call 911 immediately, even if it only lasts for a short amount of time.

Another helpful way to remember signs of a stroke is the acronym F.A.S.T. According to The Stroke Foundation, these are the signs to remember: 

• Facial drooping: Is one side of the person’s face uneven? Is there numbness or is the person’s smile unsymmetrical?

• Arms: Usually, one is experiencing a weak or numb sensation.

• Speech: Incoherent, slurred, or unable to make sense.

• Time: Immediately call 911 and let the operator know that the person is having a stroke.

Part of prevention is being aware of factors that leave you vulnerable to developing carotid artery disease. When you are well-informed, you will be proactive with screenings and lifestyle changes to decrease mitigating causes of carotid artery disease, which includes these common risk factors:

• Smoking: Being a smoker puts you at risk for carotid artery disease and PAD, among other diseases.

• Diabetes: Having diabetes leads to a 2-4x prevalence of carotid artery disease, making early detection key.

• Familial history of atherosclerosis: There is an increased risk for carotid artery disease if atherosclerosis runs in your family.

• High blood pressure: It is important to keep your blood pressure under control to prevent damage to the arterial vessels.

• Advanced age: As you get older, you are more susceptible to developing atherosclerosis, which increases the incidence of plaque buildup in blood vessels.

• Overweight: It is important to maintain a healthy lifestyle, limit sodium, and maintain an optimal weight as a preventative measure against carotid artery disease and other ailments.

• High cholesterol: Keeping your cholesterol within recommended ranges is important for your vitality and to avoid fatty buildup in your blood vessels.

• Sleep apnea: Per Heart.org, sleep apnea causes a “214% increased risk of an enlarged carotid diameter, a structural sign of vascular aging.” 

• Inactive lifestyle: Inactivity raises the risk of cardiovascular diseases such as carotid artery disease.

When a person has a stroke or TIA, medical interventions are determined by what type and how severe the cerebral event is. In the case of an ischemic stroke, it is vital to restore the blood flow to the brain. This can be done with medications such as TPA (tissue plasminogen activator), which are given through an IV and must be given within 4.5 hours of stroke symptoms to be effective. A TPA will break up clots that are blocking blood flow in your arterial vessels.

Sometimes emergency endovascular procedures need to be enacted to get rid of blockages that are causing the stroke. In these cases, TPA medication is injected via a catheter directly into the affected vessel, or a stent retriever can be utilized to remove clots. When the clot is too big, both TPA and the stent retriever are enacted.

If the arteries are not completely blocked and there is a narrowing of the vessels that is causing symptoms, a vascular surgeon can perform either a carotid endarterectomy or an angioplasty and stents. A carotid endarterectomy is a surgical intervention to remove the buildup in your arterial vessels. An angioplasty and stents are approached through a small incision at the base of the neck, and a balloon is used to open the artery to be able to place a stent and keep it open for adequate blood flow.

In the initial stages of carotid arterial disease, vascular surgeons can utilize ultrasounds, MRI, CT scans, CT angiography, or MR angiography to check the health of your arteries and detect issues before they result in a catastrophic event. The key to avoiding an ischemic stroke or TIA is prevention, early interventions, lifestyle changes, and careful monitoring for people who have carotid artery disease or other risk factors that can leave them susceptible to serious vascular events.

If you have risk factors for carotid artery disease that can lead to a stroke or TIA, establish care with an experienced vascular surgeon like Dr. David Nabi of NewportVascular.com