A carotid endarterectomy is a surgical procedure in which the carotid artery is exposed and plaque is removed, thereby reducing the risk of a thrombus breaking off and interrupting blood flow to the brain. Patients are often hospitalized for 48 hours after the procedure. Complication rates for carotid endarterectomy are approximately 3 percent.

Carotid Stenting basically involves the same technique as for coronary angioplasty. Initially, we dilate the lesion with balloon angioplasty and then place a stent across the blockage. The whole procedure takes only half an hour to 45 minutes and the risks are considerably less than carotid surgery, even though carotid stenting is just evolving. Further refinement in equipment and technique greatly reduces the risks.

However, now as we speak there is now a new treatment called stenting. As we use a stent in the arteries in the heart, we are now stenting the carotid arteries. We are one of the few centers where it is being done. And there are 70 centers in the country that are testing whether stenting is better than the operation. The operation has been highly successful and the risk of complications is only 1 to 3 per cent.

A stent is a small, slotted, stainless steel tube is placed over an angioplasty balloon catheter and threaded up the artery to the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a rigid support to hold the artery open. The stent remains in the artery permanently.

Carotid artery disease occurs when plaque builds up on the artery wall. This condition is called stenosis and is the leading cause of thrombolotic stroke. Early warning signs of stenosis can be detected by a primary care physician during a regular physical exam and include the presence of a carotid bruit or a difference in blood pressure in the right and left arms.

The main supply of blood to the brain is carried by the carotid arteries. The carotid arteries branch off from the aorta (the largest artery in the body) a short distance from the heart, and extend upward through the neck carrying oxygen-rich blood to the brain. There are four carotid arteries: the right and left internal carotid arteries and the right and left external carotid arteries. One pair (external and internal) is located on each side of the neck.

Coronary Stenting involves the placement of one or more coronary stents as part of a special balloon angioplasty procedure. A coronary stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open.

The carotid arteries are the major vessels that supply blood to the head, moving up both sides of the neck to the brain and face. When blood flow to the brain is blocked, a serious medical condition called a stroke or brain attack can occur. The narrowing or blockage is often caused by a buildup of blood clots and fatty plaques (like cholesterol) in the fork of the carotid artery where it branches into the vessels that supply blood to the face and brain.

Two tests are available to CREST physicians to pinpoint exactly how much narrowing has occurred in your carotid artery: Ultrasound, or carotid Doppler uses sound waves to measure the rate of blood flow through the artery. (You may have already had this test.) Cerebral angiography uses a contrast material injected into an artery (usually in the groin) to make the vessels in the head and neck visible in x-rays. Pictures are then taken and the amount of narrowing is measured.

Because the carotid arteries deliver blood to the brain, carotid artery disease can have serious implications by reducing the flow of oxygen and nutrients to the brain. The brain needs a constant supply of oxygen and nutrients in order to function. Even a brief interruption in blood supply can cause problems. Brain cells begin to die after just a few minutes without blood or oxygen.

Recent Articles Submit Articles Top Authors Top Articles Editorial Guidelines Contact Us Article Writing Blog RSS Builder FAQ RSS

Blood flow to the brain is restored CEA has been the standard of care for the treatment of carotid stenosis for the last four decades.

Carotid Ultrasound is a test that shows the carotid arteries (the vessels in the neck that provide blood flow to the brain). It also shows how much blood flows through the carotid arteries, and the rate of flow. Ultrasound technology (the same imaging used in pregnant women to visualize the fetus), is used to make an image of the arteries. This information can be used to find out if there is an abnormality or blockage in the carotid arteries that could lead to stroke.

Atherosclerosis is the most common cause of carotid artery disease. It is unknown exactly how atherosclerosis begins or what causes it. Atherosclerosis is a slow, progressive, vascular disease that may start as early as childhood. However, the disease has the potential to progress rapidly. It is generally characterized by the accumulation of fatty deposits along the innermost layer of the arteries. If the disease process progresses, plaque formation may take place.

Carotid artery disease may be asymptomatic (without symptoms) or symptomatic (with symptoms). Asymptomatic carotid disease is the presence of a significant amount of atherosclerotic build-up without obstructing enough blood flow to cause symptoms. Symptomatic carotid artery disease may result in either a transient ischemic attack (TIA) and/or a stroke (brain attack).

In addition to a complete medical history and physical examination, diagnostic procedures for carotid artery disease may include any, or a combination, of the following: auscultation (listening to) of carotid arteries - placement of a stethoscope over the carotid artery to listen for a particular sound called a bruit (pronounced brew-ee). A bruit is an abnormal sound that is produced by blood passing through a narrowed artery.

Take a high resolution (> 7 mHz) ultrasound linear probe and visualize the carotid arteries on both sides including the proximal portions of the internal and external carotid artery (it does not matter, if you mistake the ICA for the ECA in this case !). Look carefully for plaques defined as intimal thickening > 1.4 mm. Any plaque measuring > 1.0 has to be measured exactly (e.g. 2.3 mm) and the sum of the vertical diameter of these plaques from both sides is the plaque score.

Begin with zero, and count the number of beats for 6 seconds, then multiply by 10 to figure out your heart rate. Use your heart rate to keep your workout intensity in the zone you’ve chosen for that session. Your heart rate is just one more way of listening to your body.

Atherosclerosis is thought to play an important role in the development of carotid artery disease. Risk factors associated with atherosclerosis include: A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors. Although these risk factors increase a person's risk, they do not necessarily cause the disease.

Take a high resolution (> 7 mHz) ultrasound linear probe and visualize the intima before the carotid bulb for a length of 1.0-2.0 cm. Using the trace function, measure the area of the intima, that is clearly visible. Divide this area by the length of the area to obtain the mean intimal thickness. Perform measurements on both sides. Use the side with the higher value. Store all images and calculations on a back up media.

The Carotid arteries are located on both sides of the neck as they conduct a majority of the blood to the brain. Blockage due to atherosclerosis or cholesterol build up in the carotid arteries can result in stroke. Blockage, or “stenosis”, in the neck or carotid arteries accounts for over 200,000 strokes annually in this country. These are strokes that can be avoided if the blockages are found beforehand.

Physicians can often hear a rushing sound or “bruit” over the neck when listening during physical exam. Some people have “brain attacks” or TIA’s (Transient Ischemic Attack) before a major stroke that can alert their doctors to test the carotid arteries. Still, most people remain asymptomatic and only through screening tests such as carotid duplex ultrasound exam are we able to find the blockages.

Angioplasty is not the cure for Coronary Artery Disease and hence the chance of forming a new block or the stent getting blocked does exist. The chance of this happening depends upon multiple factors like the risk factors, the lesion(block) morphology, the intensity of disease etc. and hence will vary from patient to patient. However what can be confidently said is that the control of risk factors post angioplasty definitely reduces the chance of a new block formation or restenosis.

Anyone who has a risk factor for atherosclerosis or hardening of the arteries. Anyone who has cardiac disease. A patient with hypertension, a patient with a history of smoking, a patient with diabetes: they are all risk factors for stroke. Anyone with these risk factors should be tested. Otherwise anyone over 65 should have one screening, perhaps once a year, and have it done so that the we know that the arteries are clean and we are all happy. Let's say there is a 50% block.