Treatment of Carotid Artery Occlusion in the Neck

Doctor Name

Dr.Hossam Elmahdy

Carotid artery occlusion is often referred to as carotid artery stenosis. This condition typically occurs due to the accumulation of fatty deposits and cholesterol plaques that obstruct blood flow to the brain, increasing the risk of stroke.

Function of the Carotid Arteries:

The carotid arteries refer to two large blood vessels that supply blood to the front part of the brain, carrying oxygen-rich blood. This area is responsible for thinking, speaking, personality, as well as sensory and motor functions. You can feel the pulse of the carotid arteries on each side of the neck, below the jawline directly.

Hardening of the arteries and the accumulation of cholesterol, fats, and other substances that travel through the bloodstream lead to the buildup of plaques and narrowing or occlusion of the carotid artery, which may put the individual at risk of stroke.

Symptoms of Carotid Artery Occlusion:

Often, carotid artery stenosis does not show any signs or symptoms in its early stages, and the condition may progress unnoticed until it becomes sufficiently dangerous to deprive the brain of blood, leading to a stroke.

There are warning signs of an impending stroke, which occur when a blood clot blocks one of the arteries that supply blood to the brain for a brief period. The following symptoms may occur temporarily and may last for a few minutes or hours, individually or collectively:

Sudden loss of vision or blurred vision in one or both eyes.
Weakness and/or numbness on one side of the face, arm, or leg, or on one side of the body.
Speech impairment, difficulty speaking, or understanding what others are saying.
Loss of coordination.
Dizziness or confusion.
Difficulty swallowing.

These are strong indicators for predicting future strokes. A person who has experienced these symptoms is ten times more likely to suffer a major stroke than someone who has not experienced them.

How Carotid Artery Occlusion Occurs:

The carotid arteries are similar to the coronary arteries that supply blood to the heart, as both are susceptible to atherosclerosis. Over time, the accumulation of fatty substances and cholesterol narrows the carotid arteries. This reduces blood flow to the brain and increases the risk of stroke, as mentioned earlier.

Stroke also resembles a heart attack, occurring when blood flow to a part of the brain is cut off, and the brain cannot store oxygen. Therefore, it relies on a network of blood vessels to supply it with oxygen-rich blood. Thus, a stroke leads to a reduction in blood supply and, consequently, a decrease in nutrients and oxygen.

A stroke can occur if:

The artery becomes severely narrowed due to fatty deposits.
Part of the deposits breaks off and travels to smaller arteries in the brain.
There is a blood clot formation and blockage of the narrowed artery.

Diagnosis of Carotid Artery Occlusion:

Often, there may be no symptoms of carotid artery occlusion. If you are at risk, it is important to undergo regular physical examinations.

Professor Dr. Hossam El Mahdy, a vascular surgery professor at Cairo University, listens to the carotid arteries using a medical stethoscope. Abnormal rushing sounds may indicate carotid artery occlusion.

Diagnostic tests include:

Duplex Ultrasonography: This test involves imaging using high-frequency sound waves to visualize the carotid arteries and determine if there is narrowing. This is the most common test to assess the presence of carotid artery occlusion.
Carotid Artery Angiography (Carotid Arteriography): During this imaging procedure, a catheter is inserted into a blood vessel in the arm or leg and guided to the carotid arteries using X-rays with contrast dye injected through the catheter. This test can be performed to evaluate or confirm the presence of narrowing or occlusion in the carotid arteries, assess the risk of stroke in the future, and evaluate the need for treatment, such as carotid artery stenting.
Magnetic Resonance Angiography (MRA): This is a type of magnetic resonance imaging (MRI) that uses a magnetic field and radio waves to provide images of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from X-rays or ultrasound.
Computed Tomography Angiography (CTA): This test uses advanced computed tomography imaging technology, along with contrast dye, to obtain high-resolution three-dimensional images of the carotid arteries. It allows for the assessment of the degree of narrowing in the carotid arteries and can also evaluate the arteries leading to them, as well as the blood vessels in the brain.

Treatment of carotid artery disease involves:

Making lifestyle changes.
Taking prescribed medications.
Proceeding to therapeutic procedures.

Lifestyle changes:

To prevent the progression of carotid artery disease, lifestyle changes are recommended:
• Quitting smoking.
• Controlling high blood pressure, cholesterol, diabetes, and heart diseases.
• Undergoing regular check-ups.
• Achieving appropriate lipid levels, with harmful fats below 100 and beneficial fats above 45.
• Consuming low-fat, low-cholesterol, and low-sodium foods.
• Managing excess weight.
• Regularly engaging in exercise for at least 30 minutes most days of the week.

Medications used to treat carotid artery stenosis:

All patients with carotid artery disease should take antiplatelet medications to reduce the risk of stroke and complications from other cardiovascular diseases. Aspirin is one of the most commonly used antiplatelet medications.

Therapeutic procedures for carotid artery stenosis:

If you have symptoms related to carotid artery stenosis, you may require carotid endarterectomy or carotid artery stenting to correct the narrowing in the artery and reduce the risk of stroke. Professor Dr. Hossam El Mahdy will evaluate you to recommend the best treatment for your condition.
If you have carotid artery stenosis without symptoms, Professor Dr. Hossam El Mahdy will assess your test results and risk status to recommend whether medical treatment, carotid artery stenting, or carotid endarterectomy is the best option for you.

Carotid Endarterectomy:

Carotid endarterectomy is the traditional surgical treatment for carotid artery stenosis. It has been proven beneficial for patients with carotid artery stenosis of 50% or more who are symptomatic, as well as for asymptomatic patients with 60% or more stenosis. Carotid endarterectomy is performed under general anesthesia. During the procedure, an incision is made in the neck at the site of carotid artery stenosis. The surgeon removes the plaque from the artery, and upon completion, the vessel is sutured to close it. Blood flow to the brain is restored through its natural pathway.

Carotid Artery Stenting:

The procedure is performed while the patient is awake but under local anesthesia. During the procedure, guided by X-rays, a catheter is inserted into a blood vessel in the arm or leg and directed to the carotid artery at the site of stenosis or narrowing using specially designed guiding wires to reach beyond the stenosis area. Then, the balloon attached to the end of the catheter is inflated for a few seconds to open and expand the artery. A stent is placed in the artery and opened to fit the size of the artery. The stent remains in place permanently to support the walls of the artery and keep it open.

Research has shown that carotid artery stenting is as safe and effective as carotid endarterectomy but with less risk. Therefore, it is recommended to consult Professor Dr. Hossam El Mahdy, Professor of Vascular Surgery at Cairo University, for a detailed evaluation and selection of the best treatment for you to prevent the occurrence of a stroke.

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