The carotid arteries are the blood vessels in the neck on either side of the windpipe that carry the major supply of blood to the head and brain. Carotid artery disease is the major cause of stroke, and stroke is the third leading cause of death in the United States.

The arteries may become thickened and blocked due to atherosclerosis due to the build-up of cholesterol calcium, and fatty materials (plaque) deposited on the inner walls of the carotid arteries. This is referred to as carotid artery disease and causes decreased blood flow through the artery. Ulcers may also form inside the plaque. The ulcers have rough edges and surfaces, which may lead to blood clots or particles of plaque breaking off into the blood stream.

Stroke from atherosclerosis may be prevented by a surgery called carotid endartorectomy. The surgery is usually recommended based on the amount of stenosis, or narrowing of the carotid artery. The amount of 70%or more of blockage is often used as an indicator that the likelihood that the patient will have a stroke within the next several years is greater than the danger of an operation to remove the blockage. Even if you have no symptoms, with 70% or more blockage, it may be necessary to consider an operation.

Warning Signs & Symptoms of Carotid Artery Disease
Many people have no warning symptoms while others have temporary or sudden onset of symptoms that may include one or more of the following associated with either a cerebrovascular accident (CVA), also called a stroke, or a TIA --Transient Ischemic Attack. This recenlty has been called "Brain Attack" in the media.

TIA or Transient Ischemic Attack is a temporary interruption of the blood supply to a part of the brain. A TIA usually lasts from a few seconds to a few hours, but seldom more than 24 hours. This occurs when the normally smooth inner wall of an artery has developed a rough and narrowed surface from injury or atherosclerosis. In the blood there are special cells called platelets that help to repair any injuries by forming a clot. When a person has atherosclerosis, fatty material called plaque causes the arteries to be more easily injured and increases the chances of platelet clot breaking off, called embolus. The embolus may travel to a smaller artery beyond it, causing a temporary blockage of blood to the brain-or a TIA. The TIA is the number one warning sign that a stroke could occur. The following signs can occur individually or several can occur together. It is very important to report any of these signs to your doctor at once:

• Numbness, weakness and/or loss of coordination, or paralysis on one side of the body · Drooping on one side of the face or mouth
• Blindness or partial loss of vision in one eye, especially a "shade" coming down over one eye
• Inability to speak, or thick garbled speech
• Inability to understand written or spoken works
• Brief episodes of memory loss
• Loss of consciousness

CVA or Cerebrovascular Accident, also called Stroke A stroke occurs when blood flow to the head and brain is blocked by an embolus or narrowing of the artery with symptoms for more than 24 hours, causing damage to the brain. A stroke can occur without any warning, may be mild to severe, and usually occurs very suddenly. Some people many experience TIAs as described above as a warning of reduced blood flow to the brain. The following are signs and symptoms of a stroke if they last for more than 24 hours and it is very important to report any of these signs to your doctor at once:

• Numbness, weakness and/or loss of coordination, or paralysis on one side of the body
• Drooping on one side of the face or mouth
• Blindness or partial loss of vision in one eye
• Inability to speak or thick garbled speech
• Inability to understand written or spoken works
• Brief episodes of memory loss
• Loss of consciousness

Risk Factors in the Development of Carotid Artery Disease
Carotid artery disease can occur at any age, but is most common in people over the age of 45 years. Although no one can be sure who will develop the disease, it is known that many of those affected share many of the same habits and traits in their lifestyle. Carotid artery disease and atherosclerosis cannot be totally cured or prevented, but by changing habits and making lifestyle changes, the risks can be reduced. To learn more about reducing the risks listed below click on the highlighted link. The known risk factors include:

• Smoking history
• Hypertension (high blood pressure)
• High levels of blood cholesterol
• Diabetes
• Heart disease
• Family history of arterial disease
• Obesity (overweight)
• Sedentary (inactive) lifestyle

Diagnosis of Carotid Artery Disease
The diagnosis of atherosclerosis of the carotid arteries starts with a history of medical problems and lifestyle plus a careful examination by the physician using a stethoscope to listen to the blood flow through the arteries in the neck. He also examines the area with his hands to feel the arteries in the neck. Since it is difficult sometimes even impossible to restore lost function once a stroke has occurred, it is essential to detect carotid artery disease before the lesions can cause trouble. If the Dr. King suspects that you have carotid artery disease, you will be asked specific questions about the signs, symptoms, your medical history and general lifestyle. Depending on what the doctor hears and feel during the examination as well as any symptoms you may have experienced, special tests will be ordered to measure the amount of blood getting through or around any narrowed vessels. These tests fall into two categories; non-invasive and invasive.

Non-Invasive Testing: Non-Invasive Testing is done in the vascular laboratory either at the Beachwood office or downtown at the hospital to check the blood flow in your carotid arteries. Non-Invasive tests are painless and have no risks or side effects. They do not involve the use of needles, x-rays, or dye and no special preparation is required before the test and no observation afterwards. This often allows the tests to be done the same day as the office visit, schedule permitting. All non-invasive tests take less than one hour to perform and the results are given to Dr. King for evaluation. Often, you will discuss the results by telephone. There are several types of Non-Invasive tests that may be ordered:

• Doppler Ultrasound provides a sound analysis of the blood flow moving though the carotid arteries to your brain to measure and identify significant degrees of narrowing. A gel, which may feel cold and wet, will be placed on your neck and the technologist will use a microphone-type device pressed against your skin to listen to the blood flowing through neck.
  
• Ultrasound Imaging allows the technologist to see your carotid arteries on a small video screen. A small probe will be placed on your neck to obtain this image.
  
• Duplex Scanning This sensitive test is when Doppler Ultrasound and Ultrasound Imaging are combined to view your blood flow in color while listening to the sound of the blood flow. This exam can reveal the presence of plaque and the extent of narrowing in the carotid artery.
  

Invasive Testing: Depending on the non-invasive test results and or symptoms, an Invasive Test, known as an Arteriogram may be ordered to evaluate the specific location of any narrowing, blockage, or defect in the arteries to your brain. This is performed in the X-ray department of the hospital either as an outpatient or during hospitalization. An arteriogram is obtained by injecting dye through a small needle or catheter inserted into a blood vessel. Since it involves the puncture of an artery and injection of dye, you will be asked to sign a consent form. You will remain awake, although you may be given a medication to help you relax. You can expect the dye injection to cause a brief hot, burning sensation and once the pictures are taken, you will be required to stay in bed and lie quietly for several hours, often using a pressure bandage over the site. Once Dr. King has seen the results of the arteriogram, he will discuss the recommendations for further treatment with you.

Treatment and Surgery for Carotid Arterial Disease
Depending on the results of the testing and symptoms you are experiencing, a treatment recommendation will be discussed with you. For mild disease, treatment with medication such as aspirin, or if unable to take aspirin, either Plavix or Ticlid will often be recommended in combination with a patient commitment to lifestyle changes, such as stopping smoking to prevent the disease from worsening. You would then be monitored regularly to reassess the situation. For severe carotid artery disease with significant narrowing, an operation called carotid endarterectomy may be required.

Carotid Endarterectomy is a surgical procedure in which the plaque and inner lining of the artery is removed, or cleaned out so that blood flow is restored to the brain. During the endarterectomy a neck incision is made, the carotid arteries are located, clamps are placed above and below the surgical site then the carotid artery is opened and the plaque is carefully removed. The artery is then closed with a patch of vein or synthetic material, sutures or staples are applied to the skin incision and the whole area is covered with a dressing. The goal of surgery is to reduce the long term risk of stroke.

With the recent advances in vascular surgery, carotid surgery can usually be performed with low risk of complications. Your surgery may prevent stroke and possibly prolong your life. However, there are still some risks involved that you should consider. The risks of surgery will be discussed with you and are rare, but include bleeding, infection, anesthesia-associated risks, stroke, heart attack and death.

The carotid endarterectomy is performed in the hospital and usually patients are asked to come to the hospital that day. Post-operatively, you can usually expect one to two days in the hospital and the overall recovery period usually takes approximately 2-4 weeks. You can resume your normal activities with the doctor's permission. Your first office check-up is generally in six weeks then again at three months and annually thereafter to monitor your vascular health. At the three month visit a duplex scan is obtained.

Regardless of the surgery, atherosclerotic disease is still present. In order to help control this, you must make a commitment to keep regular follow-up appointments and vascular laboratory testing as well as changing your lifestyle to reduce as many risk factors as possible. Regular daily exercise, a low-fat, well balanced diet, maintaining a healthy weight, adhering to medication prescriptions and absolutely no tobacco consumption will help to prevent further disease.