What is carotid disease?
Atherosclerosis, also known as “hardening of the arteries”, a disease in which fat, cholesterol and calcium (plaque) build up inside the vessels that carry blood around the body (arteries). Over time plaque hardens causing narrowing of the vessels and limits the flow of blood. When it affects the carotid arteries in the neck that carry blood to the brain, it can cause stroke. People who suffer a stroke develop weakness down one side, drooping of the face and problems with their speech, vision or thinking. Stroke is a common cause of disability and death.
Am I at risk of carotid disease?
Carotid disease is associated with increasing age, smoking, high blood pressure, high cholesterol, diabetes and heart disease. Some patients will have a noise in the neck associated with the disturbed blood flow. Before a major stroke some patients have symptoms such as transient loss of vision in one eye from which they recover. Many will however have no symptoms. People who have suffered a stroke should be investigated for the presence of carotid disease.
How do I know if I have carotid disease?
Ultrasound is the best way to identify patients with atherosclerosis involving the carotid arteries and determine the severity of the narrowing and thereby the risk of stroke. Ultrasound is a non-invasive test that uses high frequency sound waves to obtain images or extent of the disease. It is not painful and does not require any injection or radiation. Ideally it should be performed by an experienced vascular sonographer who understands the assessment of patients with carotid disease. It does however only examine the carotid arteries in the neck, additional studies may be required to examine the arteries in the brain.
How is carotid disease treated?
All patients should be checked for diabetes and have their blood pressure and cholesterol under control and regularly checked by their GP. Smokers will benefit from quiting. Your GP can discuss with you being on a blood thinner, for example aspirin, to reduce the risk of stroke. Some patients benefit from surgery to clean out the carotid artery (carotid endarterectomy) in order to prevent further damage to the brain after a stroke or to help prevent a stroke in the first place. The decision to perform surgery is based on several factors including the degree of narrowing.
What are the risks of surgery?
Any procedure on the carotid arteries carries with it the risk of causing a stroke. This needs to be balanced against the risk of stroke without surgery which is particularly high in patients who have already suffered damage to the brain. Surgery also carries with it the risk of injury to the nerves that control the tongue, speech and swallowing however these nerves usually recover. There is also the risk of bleeding, especially given that patients need to continue aspirin around the time of surgery. Infection rarely occurs and in some patient’s blood pressure is difficult to control after surgery.
What are the alternatives to surgery?
Stenting is a newer procedure that involves placing a scaffold across the narrowing. It is a minimally invasive procedure carried out under local anaesthetic through the groin. In addition to stroke, complications of stenting include damage to the artery in the groin used to place the stent. Not all patients are suitable for stenting. In addition to ultrasound further testing is usually required to determine if stenting is a reasonable alternative. Dr Freeman can discuss the most suitable options for each individual and has extensive experience in treating patients with carotid disease with surgery and stenting.
Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.