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Cerebrovascular Disease
OVERVIEW
Stroke killed 157,804 people in 2003. It's the third
largest cause of death, ranking behind "diseases of the heart"
and all forms of cancer. Stroke is a leading cause of serious,
long-term disability in the United States. Carotid artery
stenosis is a leading cause of strokes.
You have two carotid arteries—one on each side of your neck,
just next to your windpipe. These arteries supply blood to the
large front section of your brain, which is responsible for
thinking, speech, personality and sensory and motor functions.
You also have two smaller arteries, the vertebral arteries that
run up your spine and supply blood to your brainstem and
cerebellum.
Just like the arteries in your heart, the carotid arteries can
narrow and develop blockages. This disease process is known as
atherosclerosis, and the blockages, made of fat and cholesterol
deposits, are called plaque. The disease can cause a decrease in
blood flow to the brain, ultimately leading to a stroke.
RISK FACTORS
The following factors may increase your chance of atherosclerosis and, as a result stroke:
- Smoking
- Family history of stroke
- Diabetes
- High blood pressure
- Race/ethnicity
- Age
- High fat/high cholesterol diet
- Prior history of stroke
- Being overweight
SYMPTOMS AND DIAGNOSIS
There are not necessarily warning signs for carotid artery
disease, but there are warning sings of and impending stroke.
Many times a stroke is preceded by a Transient Ischemic Attack
(TIA or “mini stroke”). A TIA is a temporary (lasting a few
minutes to a few hours) episode of any of the following events:
- Blurred of loss of vision in one or both eyes
- Weakness and /or numbness of your arm, leg or face on one side
of your body
- Slurring of speech, difficulty talking or understanding what
others are saying
- Loss of coordination, dizziness or confusion
- Trouble swallowing
- Headache
Note: A TIA is a medical emergency. Immediate treatment my save
your life or increase our chance of a full recovery.
Sometimes a patient may not know that he or she has diseased
carotid arteries. In these cases, it is important that the
carotid arteries are routinely assessed as part of a regularly
scheduled physical exam. Initially, the physician will listen to
the carotid arteries with a stethoscope. If an abnormal
whooshing sound, called a bruit (BROO-ee) is heard, disease may
be present. Bruits, however, are not always present when
blockage is present, and a bruit may be heard in even the most
minor of narrowings. . A carotid ultrasound will determine the
degree and location of blockage in the artery. This may need to
be confirmed by another test such as a CT scan, an MRA or an
angiogram.
TREATMENT
When a blockage is significant (generally greater
than 70%) treatment is recommended.
Carotid Endarterectomy (CEA): This surgical treatment is
preformed while the patient is under general anesthesia. An
incision is made in the side of the neck, at the location of the
blockage (generally just below the jaw), and into the carotid
artery. The plaque and any diseased portion of the artery is
sewn back together to allow blood flow to the brain.
Carotid Artery Stenting (CAS): This is a non-surgical
procedure that is performed in a catheterization laboratory. A
small puncture is made in an artery in the groin, and catheters
and wires are inserted under specialized X-ray. During this
procedure, balloons, stents (mesh-like tubes that act as
scaffolding in the carotid artery) and small filters (to capture
particles from the blockage and prevent a stroke) are placed in
the carotid artery via the previously placed catheters and
wires. |
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