Carotid Artery Stenosis (CAS)
Carotid Artery Stenosis (CAS) occurs when plaque, primarily composed of fat and cholesterol, builds up inside the carotid arteries, causing them to stiffen, a condition commonly referred to as hardening of the arteries. This narrowing restricts blood flow to the brain, depriving it of oxygen, glucose, and essential nutrients. If the plaque ruptures, it can send debris to the brain, potentially triggering a stroke.
Causes of Carotid Artery Stenosis
The carotid arteries are responsible for delivering blood to the brain. Over time, plaque can accumulate in these arteries, leading to stiffness and restricted blood flow. This blockage can result in serious complications such as stroke, especially if the plaque ruptures, blocking cerebral arteries and damaging brain tissue.
Risk Factors and Symptoms of CAS
F.A.S.T
In its early stages, CAS may not present symptoms. However, significant narrowing can lead to a stroke or a transient ischemic attack (TIA), often referred to as a “mini-stroke.” Remember the FAST acronym to identify stroke symptoms:
• Facial drooping on one side
• Arm weakness or sudden numbness
• Speech difficulties, slurred or garbled speech
• Time to call 911 immediately
Risk Factors:
Multiple risk factors significantly increase the likelihood of developing CAS, especially when three or more are present:
• Age (over 65)
• High blood pressure
• Diabetes
• Smoking
• High cholesterol
• Obesity
• Sedentary lifestyle
• Family history of stroke or arterial disease
• Poor diet
• Excessive alcohol consumption (more than two drinks per day)
Diagnosing Carotid Artery Stenosis
A duplex ultrasound is the most effective non-invasive test for diagnosing CAS. It evaluates both the structure of the artery and the blood flow. If stroke symptoms arise, seek immediate medical care for evaluation and diagnosis.
Treatment Options for CAS
Treatment approaches depend on the severity of the condition. Early stages may be managed with lifestyle changes, medications, and regular monitoring. However, in severe cases or after a stroke/TIA, surgical intervention may be necessary.
• Carotid Endarterectomy (CEA): A surgical procedure where the artery is opened, and plaque is removed to restore normal blood flow.
• Carotid Stenting: A minimally invasive procedure where a stent (a mesh tube) is inserted to keep the artery open and improve blood flow.
• Transcarotid Artery Revascularization (TCAR): A newer, less invasive procedure involving a small incision near the collarbone. A sheath is placed in the carotid artery to protect the brain while a stent is inserted to exclude the blockage.
Preventing Carotid Artery Stenosis
Preventative measures can help reduce or slow the progression of CAS, such as:
• Quitting smoking
• Maintaining a healthy weight
• Limiting fat, cholesterol, and salt intake
• Increasing fruit and vegetable consumption
• Exercising regularly
• Limiting alcohol consumption
• Managing chronic conditions like diabetes and high blood pressure
CAS Progression and Complications
Early-stage CAS may go unnoticed. However, as the narrowing worsens, the risk of stroke increases significantly. Symptoms of advanced CAS may include transient blindness in one eye, limb weakness or numbness, facial paralysis, or speech issues.
FAQs About CAS:
How is CAS diagnosed?
A non-invasive duplex ultrasound is the most effective method for diagnosing CAS and determining its severity.
What are the treatment options?
- Carotid Endarterectomy: Surgical plaque removal
- Carotid Stenting: Stent placement to widen the artery
- TCAR: Minimally invasive revascularization with brain protection
When should I seek medical help?
If you experience stroke symptoms such as sudden vision changes, limb weakness, facial drooping, or speech difficulty, call 911 immediately. Early detection and treatment are critical for preventing complications