What is Carotid Stenosis?

Your carotid arteries, located on each side of your neck, carry oxygen rich blood to the large front part of your brain where thinking, speech, personality, sensory, and motor functions take place.  
Carotid artery stenosis is a narrowing of the carotid arteries due to a buildup of cholesterol deposits called plaque or atherosclerosis.   This narrowing may lead to partial or complete blockage of one or both of the carotid arteries which decreased the amount of blood flow to the brain and increased your risk of having a stroke.

What are the Signs and Symptoms of Carotid Artery Stenosis?

You may not have any symptoms of carotid artery stenosis. Plaque builds up in the carotid arteries over time with no warning signs until you have a transient ischemic attack (TIA) or a stroke.

Signs of a TIA or stroke may include:

• sudden loss of vision, blurred vision, or difficulty in seeing out of one or both eyes
• weakness, tingling, or numbness on one side of the face, one side of the body, or in one arm or leg
• sudden difficulty in walking, loss of balance, lack of coordination
• sudden dizziness and/or confusion
• difficulty speaking (called aphasia)
• confusion 
• problems with memory
• difficulty swallowing (called dysphagia)
• sudden severe headache

How is Carotid Artery Stenosis treated?

Treatment for carotid artery stenosis is dependent upon the severity of the disease:

• For 50% narrowing or less, Dr. Cohn will treat the stenosis with antiplatelet medication and lifestyle recommendations.  We will see you every six months and perform a Carotid Duplex Ultrasound to monitor the progression of the stenosis.
• For more severe stenosis Dr. Cohn may check a Carotid angiogram.  This is a more invasive imaging procedure where a special dye is injected into the artery and x-ray movies are taken that shows a more accurate picture of the stenosis.
• For a narrowing greater that 80%, Dr. Cohn may recommend a surgical procedure called a carotid endarterectomy to remove the blockage in the carotid artery.  There is a 1-2% risk of stroke with this procedure and therefore it is only recommended for patients whose carotid stenosis is severe enough that they have a higher risk of stroke from the stenosis than they do from the procedure.

What Are the Recommended Lifestyle Changes for Carotid Artery Stenosis?

To keep carotid artery stenosis from progressing, the following lifestyle changes are recommended:

• Quit smoking.  Smoking doubles the risk for stroke.  If you stop smoking today, your risk for stroke will immediately begin to drop.  Quitting smoking today can significantly reduce your risk of stroke from this factor.
• Control high blood pressure (optimal blood pressure is 120/80 mmHg). Have it checked at least annually. If it is elevated, work with your doctor to keep it under control.  High blood pressure (hypertension) is a leading cause of stroke. You can check your blood pressure at your doctor's office, at health fairs, at home with an automatic blood pressure machine, or at your local pharmacy or supermarket.  If the higher number (your systolic blood pressure) is consistently above 120 or if the lower number (your diastolic blood pressure) is consistently over 80, talk to your doctor. If your doctor decides that you have high blood pressure, s/he may recommend some changes in your diet, regular exercise, or medicine.  Blood pressure drugs have improved. Once you and your doctor find the right medicine for you, it will almost never cause side effects or interfere with your quality of life.
• Control diabetes.  Know your numbers!  Follow your doctor's advice carefully to control your diabetes aiming to keep your Hgb AIC  to less than 7%.  Often, diabetes may be controlled through careful attention to what you eat.  Work with your doctor and your dietitian (a health care professional who helps promote good health through proper eating) to develop a healthy eating program that fits your lifestyle. Your doctor can prescribe lifestyle changes and medicine that can help control your diabetes.  Having diabetes puts you at an increased risk for stroke; by controlling your diabetes, you may lower your risk for stroke.
• Have regular check-ups with your doctor. 
• Have your doctor check your cholesterol and get treatment, if necessary.  Know your total cholesterol number along with your LDL and HDL.  If your total cholesterol level is over 200, talk to your doctor.  You may be at increased risk for stroke.
LDL, (which we like to keep below 100) known as the "bad" cholesterol, is the form that builds up and causes plaque which may narrow arteries and limit or stop blood flow.  LDL can be inherited from your family members or be a result of your body chemistry.  It can also be the result of a diet high in saturated fats, lack of exercise, or diabetes.
HDL is the "good" cholesterol that sweeps the blood and removes plaque.  The higher this number is the more protection you have!!
Lowering your cholesterol (if elevated) may reduce your risk for stroke. High cholesterol can be controlled in many individuals with diet and exercise.  Some individuals with high cholesterol may require medicine.
• Eat foods low in saturated fats, trans fats, cholesterol, and salt. By cutting down on sodium and fat in your diet, you may be able to lower your blood pressure and, most importantly, lower your risk for stroke.  Work towards a balanced diet each day with plenty of fruits, vegetables, grains, and a moderate amount of protein (meat, fish, eggs, milk, nuts, tofu, and some beans).
Adding fiber, such as whole grain bread and cereal products, raw, unpeeled fruits and vegetables and dried beans, to the diet can reduce cholesterol levels by 6 to 19 percent.
• Eat only enough calories to maintain a healthy weight; avoid weight gain.
• Increase exercise to at least 30 minutes of physical activity most days of the week. Include exercise in your daily activities.  A brisk walk for as little as 30 minutes a day can improve your health in many ways, and may reduce your risk for stroke.  Try walking with a friend; this will make it more likely that you'll make it a habit.  If you don't enjoy walking, choose another exercise or activity that you do enjoy, such as biking, swimming, golf, tennis, dance, or aerobics.  Make time each day to take care of yourself by exercising.
• Limit alcohol to one drink per day for women, two for men. Studies now show that drinking up to two alcoholic drinks per day for a man, and one alcoholic drink for a woman can reduce your risk for stroke by about half.  More alcohol than this each day can increase your risk for stroke by as much as three times and can also lead to liver disease, accidents and more.  If you drink, we recommend no more than two drinks each day for men and one each day for women, and if you don't drink, don't start! Remember that alcohol is a drug and it can interact with some drugs. It's a good idea to ask your doctor or pharmacist if any of the medicines you are taking could interact with alcohol.

Which Medications Can Reduce the Risk of Stroke?

Dr. Cohn recommends antiplatelet medications such as aspirin and/or clopidogrel (Plavix) to decrease the risk of stroke due to blood clots.  These antiplatelet medications also help keep and blood flowing smoothly in your body.

The dose of ASA is 81mg everyday.  You do not get extra benefit from a higher dose, only an increase in side effects which include GI bleeding.

The dose of Plavix is 75mg everyday.  Remember to take it about the same time everyday, with or without food.  Side effects include easy bleeding/bruising, stomach upset/pain, diarrhea, or constipation.  Some drugs interfere with Plavix.  The more common ones are the PPI’s (i.e. Nexium, Prilosec, Prevacid).  Just recently there has become a lab that is available to us in which we can check the accuracy of how you metabolize Plavix.  This may assist us with personalizing your dosage of Plavix.  If you would like to be checked please ask!