DiagnosisThe best way to identify a narrowing of the carotid artery is with an ultrasound examination performed by a trained Vascular Technologist. The use of ultrasound technology is safe, painless and, when performed by specialists, extremely accurate in diagnosing narrowing of the carotid arteries (carotid artery stenosis.) There is no radiation exposure and no risk associated with an ultrasound examination. This technology is able to estimate an approximate range of narrowing of the carotid artery that will allow the physician to recommend the best treatment option. Other ways to diagnose narrowing of the carotid artery may include the use of Magnetic Resonance Imaging (MRI) or Computed Tomography (CT scan.) MRI of the arteries (referred to as Magnetic Resonance Angiography or MRA, [figure below]) can detect stenosis (narrowing) of the carotid arteries without the use of radiation exposure. It is accurate and also allows the physician to examine the brain itself, if necessary. It does require an injection into the vein to help visualize the arteries better. CT Scanning of the Arteries (CTA) also provides information about the blood supply to the brain (carotid arteries and vertebral arteries.) However, this technique requires both radiation exposure and injection of contrast into the vein–both of which are safe when done by experts. A rare technique used to diagnose carotid artery narrowing is an angiogram or arteriogram. This requires insertion of a small tube into the artery in the groin that is passed up to the neck. From there, contrast is injected into the artery and x-ray images are taken which allows the physician to see the narrowing of the carotid arteries. As the other technologies have improved, this technique is rarely used to make the diagnosis of carotid disease in the 21st century.
Treatment OverviewThe treatment of carotid disease varies from administration of medication to surgical removal of the plaque that is narrowing the artery supplying blood to the brain. Differences of opinion vary as to when treatment should be instituted and what type of treatment is most appropriate. Those with minimal narrowing of the carotid arteries (<60%) are best managed by reducing the risk factors associated with hardening of the arteries (atherosclerosis.) This includes lifestyle modifications (smoking cessation, exercise, and dietary improvement) and appropriate management of concurrent diseases (high cholesterol, diabetes mellitus, and obesity.) Those patients who have a narrowing greater than 60% may be managed in one of several ways depending on the associated symptoms, the exact degree of narrowing and the other medical conditions affecting the patient.
The use of statin medications to control lipids is important. Additionally, the use of medicine to reduce the “stickiness” of the blood (anti-platelet drugs such as aspirin or Plavix®) is helpful in the medical management of carotid stenosis.
Balloon Angioplasty and StentingThe use of a balloon to stretch the plaque within the carotid artery followed by placement of a metal stent to hold the artery open has been shown to be effective in some instances of carotid disease. The balloon is passed up over a thin wire that has been inserted from the groin crease under x-ray guidance.
SurgeryThe use of surgery has been long-known to be safe and effective in the management of carotid disease. Through a small incision in the neck, the artery is approached, opened and the plaque scraped out returning the artery to its “normal” size.
Which Treatment Option is Best?
All options have been shown to be effective. It is important for the physician to consider all options as each patient may require a different approach. We, at The Cardiovascular Care Group, are well versed in each modality. We will recommend the treatment that is best suited for each individual patient.