Carotid Artery Conditions in India : Symptoms, Diagnosis and Treatments

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Carotid Artery Conditions

1. Carotid Artery Disease

Overview:

Carotid Artery Disease occurs due to the buildup of plaque (a process called as atherosclerosis) on the inside of the arteries. The plaque build up can lead to narrowing or blockage in the carotid artery, which may put an individual at an increased risk for stroke. The carotid arteries are located on both sides of the neck and supplies blood and oxygen to the brain.

Risk Factors of Carotid Artery Disease:

The risk factors have been linked to the development of atherosclerosis, which include:

1. - Age: Risk of atherosclerosis increase as we age. Men under the age of 75 are at higher risk of developing carotid artery disease, while women above the age of 75 have a greater risk than men.
  - Family history of atherosclerosis
  - Smoking
  - High levels of low density lipoprotein (LDL, bad cholesterol) and triglycerides in the blood.
  - Diabetes
  - High blood pressure
  - Obesity
  - Sedentary lifestyle

Generally, the carotid arteries become diseased a few years later than the coronary arteries. People having coronary artery disease and atherosclerosis have a higher risk of developing carotid artery disease.

Symptoms of Carotid Artery Disease:

Typically, carotid artery disease has no symptoms. The first sign may be a transient ischemic attack (also called as TIA or a “mini stroke”) lasting a few minutes or a few hours. Symptoms of a TIA include:

1. - Slurred speech
  - Sudden weakness or numbness on one side of the face, one arm or leg, or one side of the body
  - Difficulty talking or understanding speech
  - Loss of vision in one eye
  - Difficulty swallowing

If you experience one or more of the above warning signs, then immediately consult your physician.

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How is carotid artery disease diagnosed?

Since there may not be any symptoms of carotid artery disease, it is important to have regular physical exams if you are at risk. Your doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound called a bruit may indicate a carotid artery disease.

Diagnostic tests for carotid artery disease include:

1. 1. Carotid duplex ultrasound: An imaging procedure that uses high frequency sound waves to determine if there is narrowing in the carotid arteries. It is the most common test used for evaluating the presence of a carotid artery disease.
  2. Carotid angiography: During this invasive imaging procedure, a catheter is inserted into a blood vessel in the arm or leg and guided to the carotid arteries with the help of a special X-ray machine. A contrast dye is injected through the catheter while the X-rays of the carotid arteries are taken. This test is performed to confirm the presence of carotid artery disease, the risk of future stroke and to evaluate the need for future treatment like carotid stenting or surgery.
  3. Magnetic resonance angiogram (MRA): It is type of Magnetic Resonance Imaging (MRI) scan that uses a magnetic field and radio waves to provide the pictures of the carotid arteries. MRA provides information about the carotid and vertebral arteries and the degree of stenosis, which cannot be obtained from an ultrasound, X-ray or CT scans.
  4. Computerized tomography (CT Scan): CT scan of the brain is performed if a stroke or TIA is suspected to have occurred already. This test will reveal the areas of damage in the brain.
  5. Computed tomography angiogram (CTA): A test that uses an advanced CT technology, along with an intravenous contrast material to obtain high resolution, 3D pictures of the carotid arteries. This enables the physicians to determine the degree of stenosis in the carotid and vertebral arteries and also assess the leading arteries and blood vessels in the brain..

What are the treatments for carotid artery disease?

Carotid artery disease is treated by:

1. 1. Lifestyle modifications: The following lifestyle modifications will limit all the risk factors for carotid artery disease:
    - Control high blood pressure and diabetes.
    - Quit smoking and using tobacco products.
    - Eat foods low in saturated fats and cholesterol.
    - Have regular checkups with your doctor.
    - Exercise regularly.
    - Achieve and maintain a desirable weight.
    - Control stroke risk factors by limiting the intake of alcohol.
    - Ask your doctor to check your lipid profile and get treatment to reach a lipid goal of LDL less than 100 and HDL greater than 45.
  2. Medications: Anticoagulant medications or blood thinners are prescribed to all patients with carotid disease. You will require to take these medications to decrease the risk of stroke due to blood clotting. If you are prescribed warfarin, then blood work will be checked regularly to ensure you are on the proper dose.
  3. Procedures: If the carotid artery has several blockages or narrowing, then a procedure is performed to open the artery and allow the blood flow to the brain for preventing future stroke.
    - Carotid endarterectomy: It is a standard surgical treatment for carotid artery disease. The patient is under general anesthesia, while an incision is made in the neck at the location of the blockage. The surgeon opens the carotid artery and removes the plaque and diseased portions of the artery. The artery is sewn back to allow the blood flow to the brain.
    - Carotid stenting: It is an interventional procedure, currently under investigation. It is performed in a catherization laboratory. During this procedure, a small puncture is made in the groin. A specially designed catheter with an umbrella tip is inflated for a few seconds to dilate the artery. Then a stent is placed in the artery and opens to fit the size of the artery.

The recovery from both these procedures requires a one-night hospital stay. Patients can return to their normal activities within one to two weeks after these procedures.

1. Carotid Artery Dissection

What is carotid artery dissection?

The four carotid arteries, two on each side of the neck (an internal and external carotid), deliver blood from the aorta (heart’s main artery) to the brain, face, eyes and other structures in the head. They may be felt on each side of the lower neck, immediately below the angle of the jaw. The artery walls are made up of three layers of different types of tissue, each having a specific function.

Dissection occurs when a tear in the artery wall allows the blood to leak between the layers and separates them.

Causes: Certain medical conditions like Marfan syndrome-a genetic connective tissue disease, atherosclerosis or fibromuscular dysplasia put individuals at risk for developing carotid artery dissection. Carotid artery dissection in these patients is spontaneous that means it occurs without trauma to the head or neck.

It may also occur as a result of blunt trauma injury to the neck, such as a fall or car accident or from hyperextension of the neck in exercise or sport.

High blood pressure and smoking puts you at higher risk for both types of carotid artery dissection. Some carotid artery dissection cases have been reported after invasive diagnostic procedures.

Symptoms: Sometimes, a stroke is the first sign of carotid artery dissection and it requires emergency treatment. Symptoms develop over a period of hours or days, even in patients having traumatic injuries. The symptoms are more general rather than specific and include neck or face pain, headache, vision disturbances like droopy eyelid or a double vision, weakness on one side of the body and a sudden decrease in sense of taste.

Diagnosis: When a patient visits the doctor’s office or an emergency room with any of the symptoms mentioned above, your doctor will suspect a carotid artery dissection. He/She will choose from several different imaging technologies to diagnose your condition, these include:

1. 1. Helical computed tomography angiography (CTA) is the gold standard for trauma patients with carotid artery dissection symptoms. It is non-invasive imaging using CT technology and a contrast material to provide an accurate 3D picture of arteries on the screen.
  2. Magnetic resonance angiography (MRA) or Magentic resonance imaging (MRI) is very accurate, non-invasive imaging techniques that uses a magnetic field and radio waves for diagnosing carotid artery dissection. They show blood flow, changes in the dimension of the carotid artery, changes in the structures surrounding blood vessels and blood in the wall of the artery.
  3. Doppler ultrasonography (DUS) is a popular useful tool for identifying the carotid artery dissection. It is fast, non-invasive tool to detect an abnormal blood flow in a dissected artery.

Treatments:

In some cases, a carotid artery dissection is not diagnosed until after a stroke has developed. When a patient with carotid artery dissection symptoms arrive at the doctor’s office, the primary treatment goal of the doctor is to prevent the stroke. The appropriate treatment for an individual depends on whether the patient has experienced trauma, how and where the injury occurred and if the patient has other injuries or medical conditions.

First line treatment for the carotid artery dissection is anti-coagulant or medications to thin the blood. Anti-platelet drugs are used in combination with anticoagulants for preventing blood clot formation.

Patients who are unable to take either of the two medications, but continue to have carotid artery dissection symptoms need to undergo minimally invasive treatments. Placement of a stent and angioplasty (repairing the dissected section of the artery) are the two endovascular procedures that are used to treat a carotid artery dissection.

Outlook following carotid dissection:

Mortality is less than 5 percent for the spontaneous carotid artery dissection. Around 75% of patients with spontaneous carotid artery dissection make a good recovery. Patients with carotid artery dissection should see a vascular specialist to assess the severity and extent of the dissection.

1. Carotid Artery Tumor

Overview: A carotid artery tumor is a tumor found in the upper neck at the branching of the carotid artery. The carotid artery tumors are relatively rare and most often seen in middle aged or older people.

Causes and Symptoms of Carotid Artery Tumor:

There are no known causes for carotid artery tumor in most patients, except for hypoxia (chronic oxygen deprivation that comes from living at high altitude). In a small number of patients, there is a family connection.

It may not cause any symptoms at first, but it can be felt as a slow-growing, painless mass on the side of the neck. As the tumor enlarges over a period of several years, it may cause the following symptoms:

1. - Difficulty in swallowing
  - Hoarseness
  - Weakness or pain in the shoulders
  - Partial paralysis or numbness in the tongue
  - High blood pressure or heart palpitations
  - Drooping eyelids or vision changes
  - A bruit- distinct whooshing sound of blood pushing past an obstruction

Although, it is not an emergency, but anyone with a suspected or diagnosed carotid artery tumor should be referred to a cerebrovascular neurosurgeon for further evaluation.

Diagnosis & Treatments for Carotid Artery Tumor:

A doctor who suspects a carotid artery tumor from a physical exam will order a Doppler ultrasound to detect the tumor. A CT scan, MRA or MRI scans may also be used to confirm the presence of the tumor.

Carotid artery tumors may be treated with radiation or surgery, depending upon the size od the tumor and the age and overall health of the patient.

Surgical treatments for carotid artery tumors:

Vascular surgeons perform the transcatheter embolization and bypass graft along with surgeons in otolaryngology for the multidisciplinary treatment of carotid artery tumors.

1. Transcatheter embolization: Two to three days prior to the surgical resection of the tumor, your doctor will try to stop or reduce the blood supply to the tumor by injecting medication using a procedure called transcatheter embolization. Initially, the surgeon will inject a dye to define the feeding arteries and draining veins that feeds the tumor, so that they can be identified. They can be occuluded with embolic materials like metal coils, foam, plastic particles, glue or ethanol.
2. Surgical removal/resection: Resection of the tumor can be accomplished without concomitant repair or resection of the carotid artery in 60 to 70 percent of patients. Approximately, 10 percent of cases, a simple suture repair of the carotid artery is necessary. Most complicated carotid artery repair is required in upto 25% of patients. This type of repair depends on the type of defect created by the resecting tumor and may include patching of a hole created by tumor resection or replacing a segment of the carotid artery with a bypass graft. In more complex repairs, a temporary shunt is placed in the carotid artery to allow continous flow of blood to the brain.

Consult your healthcare provider to determine the best treatment option for you. Before choosing any treatment, you should discuss the potential benefits, risks and side effects with your physician. Patients will receive specific guidelines to help you prepare for the procedure as well as with specific instructions for your recovery.

Why Prefer an Indian Hospital for Treating the Carotid Artery Conditions?

With the rapidly evolving technology, the Indian hospitals have international quality and protocols for medical care and an international accreditation with JCI, ISO, etc. The state of the art hospitals and latest equipments ensure to offer complete medical care to cater the needs of the foreign medical tourists in India. Indian cardiologists, neurointerventionalist and the vascular surgeons have performed over 200 endovascular procedures on patients with carotid artery disease each year.

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