The carotid arteries are the two main arteries (one on each side of the head) that carry blood to the brain. Like the arteries in the heart, the carotid arteries can become narrowed by atherosclerosis. This occurs when fat, cholesterol and other substances combine to form plaque along the inner wall of portions of an artery.

Carotid artery disease is more common in older men and women. The Society for Vascular Surgery estimates one percent of adults 50 to 59 have significant narrowing in their carotid arteries. By 80 to 89, about 10 percent of American adults have significant carotid artery disease.

The main consequence of carotid artery disease is a stroke. It can occur when the plaque builds up enough to close off the affected artery (stenosis), when a blood clot becomes trapped in the narrowed portion of the carotid artery or when a piece of plaque breaks away from the deposit, travels up to the brain and becomes wedged in a narrow cerebral artery.

The American Heart Association estimates 700,000 Americans experience a stroke each year. Researchers estimate carotid artery stenosis causes 10 to 20 percent of all strokes.

Treating Carotid Artery Disease

Initially, doctors may recommend conservative treatment for patients with carotid artery disease. Patients should stop smoking, limit alcohol intake, exercise and control underlying medical conditions (like high blood pressure, elevated cholesterol, diabetes, heart disease and heart rhythm problems). Blood-thinning or anti-clotting medications may be given.

When the carotid artery is severely narrowed (generally 70 percent of more), doctors may recommend a surgical procedure, called carotid endarterectomy. An incision is made into the neck. The artery is temporarily clamped to stop the flow of blood. Then, an incision is made into the artery. The diseased area is removed and the artery is stitched closed.

Carotid Stenting

Some patients with carotid artery disease may be offered carotid stenting. Doctors use balloon angioplasty to compress the plaque. As the balloon expands, it pushes the plaque against the walls of the artery. The balloon also opens a metal framework, called a stent. The stent acts like a scaffold to hold the plaque against the arterial wall and keep the artery open.

The stent procedure is less invasive than a carotid endarterectomy. However, Mark Wholey, M.D., an Interventional Radiologist with the University of Pittsburgh Medical Center, says, tiny pieces of the plaque can break off during the procedure and lead to a stroke. Researchers say older age, heavy calcification and having tortuous (twisting) blood vessels increase the risk for having a stroke after carotid stenting. But stroke can occur in younger, seemingly healthier patients. And some older patients can safely have the stent procedure.

A new tool may help doctors determine who may be the best candidate for carotid stenting. It's called the Volcano intravascular ultrasound (IVUS). Instead of taking images from outside the body, IVUS takes the pictures from inside the blood vessel. A catheter with an ultrasound tip is snaked through the circulatory system up to the carotid artery. Sound waves are emitted from the ultrasound device (transducer). The waves bounce off the walls inside the arteries and then are picked back up by the transducer. The sounds reflect the density of the tissue along the wall. The information is analyzed by a computer, which creates a color image of the interior of the vessel. Green areas represent fibrous tissue that rarely breaks off. However, yellow shows a calcified lipid core that may be prone to rupture.

Wholey says doctors can use pictures from the IVUS to determine if a patient may be a better candidate for stenting or endarterectomy. Generally, the more amount of yellow, the greater the risk for stroke. Wholey has used the Volcano IVUS to determine treatment directions for 52 patients. So far, he has not experienced any stroke among those patients selected for stenting.

For information on the Volcano Ultrasound, http://www.volcanotherapeutics.com.

For information on carotid artery disease and stroke:

American Heart Association

Angioplasty.org

The National Heart, Lung and Blood Institute

The National Institute of Neurological Disorders and Stroke

The Society for Vascular Surgery