The blood vessels leading from the heart to the brain are called the carotid arteries. Like all arteries, these vessels can become diseased and form atherosclerotic plaques. Factors such as smoking, high blood pressure, diabetes, high cholesterol and age contribute to the formation of this kind of disease.

The majority of this kind of disease goes unnoticed and causes few issues. Sometimes however this disease can become unstable and result in debris from the plaque breaking off and blocking the small vessels supplying the brain.

Asymptomatic disease

Asymptomatic carotid artery disease can usually be managed effectively with simple measures - medications and lifestyle changes. In certain circumstances even patients who have not had symptoms MAY benefit from a procedure of the kind mentioned below.

Exercising 30 minutes three times a week, improving diet, ensuring adequate blood sugar levels and ceasing smoking are important lifestyle modifications that will improve your arterial health. Medications that lower your cholesterol called statins will most likely be prescribed, as will a blood thinner such as aspirin. If your blood pressure is high suggestions will be made to improve this as well. Any diabetic medication will need to be adjusted to ensure your blood sugar levels are improved.

Symptomatic disease

Sometimes a small event, a TIA, can be an indication that a larger stroke may be imminent. This is more likely when the plaque inside the carotid artery is causing a tight narrowing of the vessel. This will be determined on imaging - ultrasound or CT scan.

If you have had symptoms and are found to have a narrowed artery then, in addition to the treatments listed above, you MAY benefit from surgery. Surgery will not improve any issues already caused, the aim is to prevent a further bigger and potentially devastating event.

Surgery usually takes one of two forms.

Carotid Endarterectomy

This is the gold standard procedure and is an open procedure where the blood flow to the brain is diverted and the disease in the vessel removed. The vessel is closed with a patch of synthetic material.

Carotid Stent

While appealing due to its less invasive nature, carotid stenting has been shown to be less effective than endarterectomy in symptomatic patients and is only advised in a small set of specific circumstances.

Dr Werner-Gibbings is proficient at both forms of treatment and will work with you to determine the best treatment option for you.

Remember

Not all strokes are caused by blockages in the carotid arteries and not all blockages benefit from surgery. Carotid surgery is an area of much ongoing research and treatment decisions can be very complex.