Carotid Artery Occulusive Disease
Carotid artery disease may cause no symptoms until a stroke occurs or may be suggested by symptoms of a mini-stroke transient ischemia attack (TIA) or by unilateral blind episodes (amaurosis fugax). Often, the only sign suggestive of a problem is a noise or bruit, heard by a stethoscope, in your neck.
The diagnosis of carotid artery stenosis (artery narrowing) is generally confirmed by a noninvasive Duplex ultrasound scan. Further anatomic detail may require angiography (Figure 1) or magnetic resonance imaging of the upper aorta, carotids, vertebrals, and intracranial vessels. If a significant narrowing of the internal carotid artery is noted, then operative intervention along with optimal medical management (aspirin, control of hypertension, diabetes, hyperlipidemia, cessation of smoking, and exercise) has the best chance of preventing a debilitating stroke. There is no intervention that can reverse the symptoms of an established stroke, so an expedient operation is best. The current best surgical option is a carotid endarterectomy, which involves open removal of the offending plaque.
This operation can usually be performed as an early morning admission with discharge in one or two days. Asymptomatic patients with greater than a 60 percent narrowing, can expect a reduction in stroke events from 11 percent to less than 5 percent at five years with surgery. Those having experiences an event (minor stroke, TIA, or amaurosis fugax) can benefit from a greater than 50 percent reduction in stroke risk within five years of surgery. This benefit is realized even with a surgical risk of stroke/death in the 2-5 percent range. The new avenue of carotid stenting is in an experimental stage only.