Vascular and Endovascular Surgery

Carotid Artery Disease

Carotid artery disease, also called carotid artery stenosis, occurs when the carotid arteries, the main blood vessels that carry oxygenated blood to the brain, become narrowed. The narrowing of the carotid arteries is most commonly related to atherosclerosis (a build-up of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery). Atherosclerosis, or "hardening of the arteries," is a vascular disease (disease of the arteries and veins).

Carotid artery disease is similar to coronary artery disease, in which blockages occur in the arteries of the heart, and may cause a heart attack.

What causes carotid artery disease?

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. Plaque is made up of deposits of smooth muscle cells, fatty substances, cholesterol, calcium, and cellular waste products. This thickening narrows the arteries and can decrease blood flow or completely block the flow of blood to the brain.

Risk factors associated with atherosclerosis include: older age, male, family history, race or ethnicity, hyperlipidemia (elevated fats in the blood), hypertension (high blood pressure), smoking, diabetes obesity and a diet high in saturated fat.

How is carotid artery disease diagnosed?

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. A bruit is generally considered a sign of an atherosclerotic artery; however, an artery may be diseased without producing this sound.
• Carotid artery duplex scan - a type of vascular ultrasound study performed to assess the blood flow of the carotid arteries. A carotid artery duplex scan is a noninvasive (the skin is not pierced) procedure.
• Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
• Angiography - an invasive procedure used to assess the degree of blockage or narrowing of the carotid arteries by taking x-ray images while a contrast dye in injected.

Surgical treatment for carotid artery disease:

Carotid artery disease (asymptomatic or symptomatic) in which the narrowing of the carotid artery is less than 50 percent is most often treated medically. Asymptomatic disease with less than 70 percent narrowing may also be treated medically, depending on the individual situation.

Surgical treatment of carotid artery disease includes:

• Carotid endarterectomy (CEA) - Carotid endarterectomy is a procedure used to remove plaque and clots from the carotid arteries, located in the neck. Endarterectomy may help prevent a stroke from occurring, particularly in persons with a carotid artery narrowing of 80 percent or more.
   
• Carotid artery angioplasty with stenting (CAS) - Carotid angioplasty with stenting is a minimally invasive procedure in which a very small hollow tube, or catheter, is advanced from a blood vessel in the groin to the carotid arteries. Once the catheter is in place, a balloon may be inflated to open the artery and a stent is placed. A stent is a cylinder-like tube made of thin metal-mesh framework used to hold the artery open.
   
  Because there is a risk of stroke from bits of plaque breaking off during the procedure, an apparatus, called an embolic protection device, may be used. An embolic protection device is a filter (like a small basket) that is attached on a guidewire to catch any debris that may break off during the procedure. While this procedure is performed widely, the long-term effects are still being studied.

To schedule an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.

Our Offices

Camden
Three Cooper Plaza, Suite 403
Camden, New Jersey 08103
Appointments (856) 342-3113
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Marlton
127 Church Road, Suite 400
Marlton, New Jersey 08053
Appointments (856) 342-3113
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Voorhees
6017 Main Street
Voorhees, New Jersey 08043
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Washington Township
Bunker Hill Plaza, Suite 202
Sewell, New Jersey 08080
Appointments (856) 342-3113
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Our Physicians

• Babak Abai, M.D.
• James B. Alexander, M.D.
• Jeffrey P. Carpenter, M.D.
• Joseph V. Lombardi, M.D.