CAROTID STENOSIS

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Carotid stenosis, also known as carotid artery disease, is a condition where the carotid arteries, the main blood vessels that supply blood to the brain, become narrowed or blocked due to the buildup of fatty deposits called plaques. This can reduce blood flow to the brain and increase the risk of stroke.

Carotid stenosis is relatively common, especially in older adults and those with risk factors such as high blood pressure, high cholesterol, smoking, diabetes, and a family history of cardiovascular disease. It is a significant cause of stroke, which is a leading cause of disability and death.

Carotid stenosis often develops slowly and may not cause symptoms until it is severe. When symptoms do occur, they can include:

• Transient ischemic attacks (TIAs), or mini-strokes, which cause temporary symptoms such as:
  • Sudden weakness or numbness in the face, arms, or legs, often on one side of the body
  • Sudden difficulty speaking or understanding speech
  • Sudden vision problems in one or both eyes
  • Sudden dizziness or loss of balance
• Stroke, which can cause more permanent and severe symptoms similar to those of a TIA but lasting longer and potentially leading to long-term disability.

Diagnosing carotid stenosis involves several steps:

• Medical History and Physical Exam: Your doctor will ask about your symptoms and risk factors and listen to your carotid arteries with a stethoscope for sounds of turbulent blood flow (bruits).
• Imaging Tests: Various imaging techniques are used to visualize the carotid arteries and assess the severity of the stenosis:
  • Ultrasound: A non-invasive test that uses sound waves to create images of the carotid arteries and measure blood flow.
  • CT Angiography (CTA): Combines a CT scan with a contrast dye to provide detailed images of the blood vessels.
  • Magnetic Resonance Angiography (MRA): Uses magnetic fields and contrast dye to create detailed images of the carotid arteries.
  • Cerebral Angiography: An invasive procedure where a contrast dye is injected into the blood vessels, and X-rays are taken to visualize the arteries.

Treatment for carotid stenosis aims to prevent strokes and improve blood flow to the brain. Options include:

• Lifestyle Changes: Adopting a heart-healthy lifestyle can help manage risk factors. This includes eating a balanced diet, exercising regularly, quitting smoking, and controlling conditions like high blood pressure, high cholesterol, and diabetes.
• Medications: Drugs may be prescribed to manage risk factors and reduce the risk of stroke. These can include antiplatelet medications (like aspirin), cholesterol-lowering medications (statins), and blood pressure-lowering drugs.
• Surgical Procedures: In severe cases, procedures may be needed to restore proper blood flow:
  • Carotid Endarterectomy: A surgeon makes an incision in the neck to open the carotid artery and remove the plaque buildup. This is the most common surgery for severe carotid stenosis.
  • Carotid Artery Stenting: A less invasive procedure where a catheter is inserted into the artery, and a stent (a small mesh tube) is placed to widen the artery and keep it open. This is often used for patients who are at high risk for surgery.

There are two main surgical techniques for treating carotid stenosis:

• Carotid Endarterectomy: This involves making an incision in the neck to access the carotid artery, then removing the plaque and repairing the artery. It is considered the gold standard treatment for severe carotid stenosis and is highly effective in preventing strokes.
• Carotid Artery Stenting: A catheter is inserted through a small puncture in the groin or arm and guided to the carotid artery. A balloon is inflated to widen the artery, and a stent is placed to keep it open. This procedure is less invasive than endarterectomy and is an option for patients who cannot undergo traditional surgery.

Early detection and treatment of carotid stenosis can significantly reduce the risk of stroke and improve outcomes. If you experience symptoms or have concerns about carotid stenosis, it's important to consult your healthcare provider for a thorough evaluation.