About Carotid Stenosis

General Information
Carotid stenosis is a narrowing of the carotid artery (usually
the internal carotid artery).
The most common cause is artherosclerosis, which can
cause transient ischemic attacks (TIAs) with stroke-like
symptoms due to blockage of a blood vessel by an
atherosclerotic lesion or to reduced blood flow.
Symptoms
Symptoms of transient ischemic attacks caused by carotid
stenosis may include paralysis, weakness or numbness of
one or both extremities on one side of the body; loss of
vision in one eye or in part of one eye; loss of vision off to
one side; sensory defect; or language disturbances ranging
from mild to complete loss of speech.
Diagnosis
Cerebral angiography
Angiography involves injecting a contrast agent through a
catheter followed by x-rays of the head.
The procedure carries small risks of temporary neurological
complications, permanent stroke and, very rarely, death.
Although low risks, they make angiography undesirable as
a screening technique.

Carotid Doppler ultrasound

This screening technique is widely used for evaluating
carotid vascular disease.
The velocity of the flow of blood through the carotid artery
is used to determine the degrees of stenosis.

Magnetic resonance angiography (MRA)

MRA is a noninvasive procedure that uses various magnetic
resonance imaging (MRI) techniques to produce
angiographic images.
Treatment
Medical management
Options include aspirin or other anti-platelet medications,
anticoagulation, blood-pressure and cholesterol-fighting
medications, and intervention to help patients stop
 smoking.

Carotid endarterectomy
Among patients with certain kinds of transient ischemic
attacks or mild stroke within 120 days of surgery and high-
grade stenosis (greater than 70 percent blockage), using
endarterectomy to surgically open the artery reduces the
rate of stroke over the next 18 months by 17 percent and
the risk of death by 7 percent.
Factors increasing risks of this procedure include age,
cardiovascular and pulmonary disease, chronic TIAs and
recent stroke.
Outcome
Possible complications related to endarterectomy include
headache, hypertension, and a 5 percent risk of minor or
severe stroke.
Other potentially serious but rare complications include
disruption of arterial closure; post-operative TIAs; seizures
due to hyperperfusion, blood clot or hemorrhage; carotid
artery closure; post-operative carotid artery closure;
intracerebral hemorrhage; cranial nerve injury, which may
result in difficulty speaking, chewing and swallowing due to
tongue movement abnormalities; and vocal cord paralysis.
The Neuro-ICU cares for patients with all types of
neurosurgical and neurological injuries, including stroke,
brain hemorrhage, trauma and tumors. We work in close
cooperation with your surgeon or medical doctor with
whom you have had initial contact. Together with the
surgeon or medical doctor, the Neuro-ICU attending
physician and team members direct your family member's
care while in the ICU. The Neuro-ICU team consists of the
bedside nurses, nurse practitioners, physicians in specialty
training (Fellows) and attending physicians.