The most common cause of stroke is arteriosclerotic disease of the carotid arteries, which are the large arteries on either side of the neck. They carry the major supply of blood to the brain.

Arteriosclerosis affects the carotid arteries in dangerous ways by producing stenosis (narrowing), ulceration (a scooped-out, irregular area in the site), or a combination of stenosis and ulceration.

Stenosis

The narrowing of the carotid artery/arteries results in diminished blood flow to the brain and can result in stroke by complete occlusion (closure) of the artery or formation of a blood clot which can break off and go to the brain resulting in the death of brain tissue.

Another common problem that results from diminished cerebral blood flow through a narrowed (stenotic) carotid artery is transient ischemic attacks.

Transient ischemic attacks are, by definition, transitory in nature. They are generally recurrent, and oftentimes mimic a stroke, but the symptoms are self-limiting and spontaneously resolve without residual neurologic loss.

Ulceration

The carotid ulcerated plaque (arteriosclerotic formation) may be harmful because it sends small blood 

Also, large blood clots may form in these areas of ulceration and result in a large, significant stroke if these clots become mobile in the blood stream.

The ulcerated areas in the carotid arteries pose another serious problem in that dissection may occur whereby this ulcerated area becomes partially elevated, completely occluding the artery, which results in a massive stroke.

Detection & Evaluation of Carotid Artery Disease

Technology that allows non-invasive procedures to view inside your body, such as an MRI and ultrasound, are important diagnostic tools in carotid artery disease, but there are many ways it can be detected.

1. History of transient ischemic attacks or previous stroke (Note: Not all transient ischemic attacks or strokes are a result of carotid artery disease.)

2. The doctor may hear a problem with the carotid artery by listening over the artery with a stethoscope.

3. The patient may hear a swishing noise in one or both
 

4. Carotid duplex ultrasound testing (non-invasive scanning of the carotid arteries) is a valuable screening test.

5. MRA - magnetic resonance angiography – is a more finite and sophisticated non-invasive test, which can be used to detect carotid artery disease.

6. Pan cerebral arteriogram - radioplaque dye is injected in the carotid arteries and followed via x-ray through the brain. This test is performed generally by a catheter inserted in the femoral artery, which is then passed to the area of the carotid arteries, and dye is injected yielding a complete map of the carotid arteries as well as the arteries in the brain.
 

Treatment Options for Carotid Artery Disease
Like the technology that has advanced the ability to diagnose carotid artery disease, new medications and technology provide opportunities to treat the disease.

1. For stenosis (narrowing) less than 70% and/or shallow ulceration, drugs that inhibit platelet function i.e.: aspirin/aspirin-like products, coumadin, etc. have proven effective. These agents inhibit blood clotting.

2. For stenosis of 70% or greater and/or significant ulceration, surgery by a well qualified vascular surgeon should be considered provided other diseases that would cause the operative risk to be too great may exist as assessed by the patient's physician.

There are many risks for carotid artery disease that can be modified, including:

High Blood Pressure

Elevated 

Homocysteine Levels

Use of Tobacco Products

Diabetes Mellitus

Obesity

Certain Types of Heart Disease

Asymptomatic Carotid 
Artery Stenosis or 
Bruit

Excess Alcohol Consumption

If you take steps, under the guidance of your physician, to eliminate these risk factors from your life, you will lower your risk of developing carotid artery disease and stroke.

 Respectfully,

B.P. Loughridge