Carotid Stenosis

About Carotid Stenosis

General Information

• Carotid stenosis is a narrowing of the carotid artery (usually the internal carotid artery).
• The most common cause is artherosclerosis, which can cause transient ischemic attacks (TIAs) with stroke-like symptoms due to blockage of a blood vessel by an atherosclerotic lesion or to reduced blood flow.

Symptoms

• Symptoms of transient ischemic attacks caused by carotid stenosis may include paralysis, weakness or numbness of one or both extremities on one side of the body; loss of vision in one eye or in part of one eye; loss of vision off to one side; sensory defect; or language disturbances ranging from mild to complete loss of speech.

Diagnosis

• Cerebral angiography
  • Angiography involves injecting a contrast agent through a catheter followed by x-rays of the head.
  • The procedure carries small risks of temporary neurological complications, permanent stroke and, very rarely, death.
  • Although low risks, they make angiography undesirable as a screening technique.
• Carotid Doppler ultrasound
  • This screening technique is widely used for evaluating carotid vascular disease.
  • The velocity of the flow of blood through the carotid artery is used to determine the degrees of stenosis.
• Magnetic resonance angiography (MRA)
  • MRA is a noninvasive procedure that uses various magnetic resonance imaging (MRI) techniques to produce angiographic images.

Treatment

• Medical management
  • Options include aspirin or other anti-platelet medications, anticoagulation, blood-pressure and cholesterol-fighting medications, and intervention to help patients stop smoking.
• Carotid endarterectomy
  • Among patients with certain kinds of transient ischemic attacks or mild stroke within 120 days of surgery and high-grade stenosis (greater than 70 percent blockage), using endarterectomy to surgically open the artery reduces the rate of stroke over the next 18 months by 17 percent and the risk of death by 7 percent.
  • Factors increasing risks of this procedure include age, cardiovascular and pulmonary disease, chronic TIAs and recent stroke.

Outcome

• Possible complications related to endarterectomy include headache, hypertension, and a 5 percent risk of minor or severe stroke.
• Other potentially serious but rare complications include disruption of arterial closure; post-operative TIAs; seizures due to hyperperfusion, blood clot or hemorrhage; carotid artery closure; post-operative carotid artery closure; intracerebral hemorrhage; cranial nerve injury, which may result in difficulty speaking, chewing and swallowing due to tongue movement abnormalities; and vocal cord paralysis.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide