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Carotid Clinic
The INI Carotid Clinic
The INI Carotid Clinic specializes in complex cerbrovascular diseases. We offer advanced techniques to treat carotid artery disease and prevent stroke. Our team is committed to the best medical and surgical treatment methods. The carotid arteries are responsible for about 75-80% of the entire brain’s blood flow - basically serving as your blood supply's "highway to the brain". When this highway is narrowed or blocked, resulting in a stroke. About 800,000 strokes occur every year, making it the leading cause of adult disability and nursing home admission.
What is Carotid Artery Disease?
Carotid Artery Disease is a condition caused by the narrowing of the arteries in the neck that supply blood to the brain. A healthy artery is open and allows the blood to flow to the brain. Blood flow can become partially or totally blocked by fatty material called plaque. As more plaque forms, the artery becomes narrower and the walls become irregular, which can cause blood clots to form on the plaque. This can lead to stroke.
The carotid arteries are the main blood vessels to your brain. Carotid arteries are located on each side of your neck and supply blood to your brain. Plaque forms when the internal carotid arteries become blocked by fat and cholesterol build-up. This process is called atherosclerosis. When the internal carotid arteries are blocked, blood supply to the brain is reduced, and may lead to a stroke.
The plaque may also cause blood to flow abnormally, possibly leading to blood clots. A clot may can either remain at the site of narrowing and prevent blood flow to all of the smaller arteries it supplies or it can travel and wedge into smaller vessels. This is called an embolism. If a clot or plaque blocks the blood flow to your brain, it can lead to an ischemic stroke, which may cause brain damage or death. If a clot or plaque blocks a tiny artery in the brain, it may cause a transient ischemic attack (TIA), also known as a mini-stroke.
Severe blockage is called carotid stenosis and may cause you to experience a TIA. Common temporary symptoms include difficulty speaking or understanding others, loss or blurring of vision in one eye, and loss of strength or numbness in an arm or leg. Usually these symptoms resolve in less than 10 to 20 minutes, and almost always within one hour. Even if all the symptoms resolve, it is very important that anyone experiencing these symptoms call 911 and immediately be evaluated by a qualified doctor.
Carotid stenosis is frequently asymptomatic. Your doctor may detect it through an abnormal sound called a bruit (BROO'e) when listening to your carotid arteries with a stethoscope. If you are concerned about the possibility of carotid artery disease, ask your primary care physician for a referral tothe INI Carotid Clinic.
Risk Factors for Carotid Artery Disease
You may be at risk for carotid artery disease if you:
- Are 50 years or older
- Smoke
- Are Diabetic
- Are Overweight
- Have a family history of carotid disease
- Suffer from high blood pressure or high cholesterol
Symptoms of Carotid Artery Disease
Symptoms of carotid artery disease include
- weakness
- numbness
- paralysis
- slurred speech
- vision problems
Diagnosing Carotid Artery Disease
Assessing the carotid arteries is part ofa routine physical exam. Doctors feel the carotid artery and listen forany noises, called bruits, with their stethoscope. If narrowing of the carotid arteries is suspected, your physician may use onr of the following tests to further evaluate your carotid arteries,:
- ultrasound, which uses sound waves to measure the thickness of the carotid arteries and how fast blood flows through them.
- angiography, in which a dye is injected into the arteries as X-rays are taken
- computed tomographic angiography (CTA), which images carotid arteries and can show evidence of prior stroke.
- magnetic resonance angiography (MRA), which uses magnetic fields to image carotid arteries and can show evidence of prior stroke
Treating Carotid Artery Disease
Carotid Artery Disease can be treated both medically and surgically depending upon the severity of the disease. Specific treatment for carotid artery disease is customized for each patient by the experienced team at the INI Carotid Clinic. Some factors that influence treatment options are:
- your age, overall health, and medical history
- severity of the disease
- your signs and symptoms
- your tolerance of specific medications, procedures, or therapies
- expectations for the course of the disease
- your opinion or preference
Carotid artery disease may be treated medically or surgically.
Medical treatment for carotid artery disease may include:
- modification of risk factors
Risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, and elevated blood pressure.
Medications, including:
- antiplatelet medications - medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel (Plavix), and dipyridamole (Persantine) are examples of antiplatelet medications.
- anticoagulants - also described as "blood thinners," these medications work differently than antiplatelet medications to decrease the ability of the blood to clot. An example of an anticoagulant is warfarin (Coumadin).
- antihyperlipidemics - medications used to lower lipids (fats) in the blood, particularly cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others.
- antihypertensives - medications used to lower blood pressure.
Surgical treatment of carotid artery disease includes:
Carotid Endarterectomy
You will be given either a general or local anesthetic before surgery. In this procedure, the neurosurgeon makes an incision in your carotid artery and removes the plaque using a dissecting tool. Removing the plaque is accomplished by widening the passageway, which helps to restore normal blood flow. Your artery will be repaired with sutures or a graft. The entire procedure usually takes about two hours. You may experience pain near the incision in your neck and some difficulty swallowing during the first few days after surgery. Most patients are able to go home after one or two days, and return to work, usually within a month. You should avoid driving and limit physical activities for a few weeks after your surgery.
There are potential complications with carotid endarterectomy surgery, just as there are with any type of surgery. There is a 1 to 3 percent risk of stroke following surgery. Another fairly rare complication is the re-blockage of the carotid artery, called restenosis. This may occur later, especially in cigarette smokers. Numbness in your face or tongue caused by temporary nerve damage is a possibility, but uncommon. This usually clears up in less than one month and most often does not require any treatment
Carotid Angioplasty and Stenting (CAS)
An alternative form of treatment, carotid angioplasty and stenting, is promising for patients who may be at too high risk to undergo surgery. Carotid stenting is a procedure in which a tiny, slender metal-mesh tube is fitted inside your carotid artery to increase the flow of blood blocked by plaques. The stent is inserted following a procedure called angioplasty, in which the doctor guides a balloon-tipped catheter into your blocked artery. The balloon is inflated and pressed against the plaque, flattening it and re-opening the artery. The stent acts as scaffolding to prevent the artery from collapsing or from closing up again after the procedure is completed.
You are awake during this procedure, and usually discharged from the hospital the following day. Most patients are able to resume normal activities when they get home.
There are several potential complications of endovascular treatment. The most serious risk from carotid stenting is an embolism, caused by a disrupted plaque particle breaking free from the site. This can block an artery in the brain, causing a stroke. These risks are minimized using small filters called embolic protection devices in conjunction with angioplasty and stenting. There is also a slight risk of stroke due to a loose piece of plaque or a blood clot blocking an artery during or right after surgery.
Hyperperfusion, or the sudden increased blood flow through a previously blocked carotid artery and into the arteries of your brain can cause a hemorrhagic stroke. Other complications include restenosis and short periods of medically treatable reduced blood pressure and heart rate.
Although surgery may reduce your risk of stroke, it does not stop plaque from building up. To prevent your arteries from hardening again, the following health tips may help:
- Eat foods low in saturated fat, cholesterol, and calories
- Exercise regularly, especially cardio exercises such as walking
- Maintain your ideal body weight
- Avoid smoking
- Discuss taking cholesterol-reducing medications with your doctor
Carotid endarterectomy and carotid angioplasty and stenting are proven to reduce the risk of stroke. Patients typically feel well in a matter of days following surgery and see their surgeons within one month following intervention. Temporary nerve injury, leading to hoarseness, difficulty swallowing, or facial numbness, can occur and typically resolves within one month without further treatment.
About the INI Carotid Clinic
The INI Carotid Clinic specializes in complex cerbrovascular diseases. We offer advanced techniques to treat carotid artery disease and prevent strokes. Our team is committed to the best treatment methods, high success in surgical outcomes. The INI Carotid Clinic is the only clinic in the Midwest providing brain specialists in Stroke Neurology, Vascular Neurosurgery, Vascular Surgery, Interventional Radiology, and Neurointerventional Surgery to every patient with carotid disease in the same visit. This “one-stop shopping” offers patients with carotid disease same day diagnostic testing followed by comprehensive multi-specialty physician evaluation during a single visit. This eliminates the need for multiple referrals and appointments. They also have access to the latest research in medical, surgical and catheter-based carotid therapies, thanks to a team of leading experts. Since its formation five years ago, the INI Carotid Clinic brain specialists have provided this comprehensive care to more than 2000 patients with carotid disease.
The INI Carotid Clinic team consists of the following specialists:
- Vascular and neurovascular surgeons with rich experience in stroke care and research.
- Vascular neurosurgeons with extensive experience in surgical treatment of complex extra cranial vascular disease.
- One of the nation’s premier teams of interventional radiologists and neurointerventional surgeons. Together, the team has more than 75 years of researching and teaching endovascular diagnosis and treatment.
- Significant local experience in carotid stents and catheter-based treatment of stroke.
The Carotid Clinic Team members include:
Stroke Neurologists
David Wang, DO; Arun Talkad, MD; Deepak Nair, MD
Interventional Radiologists
Raymond Bertino, MD; Terry Brady, MD; Kenneth Moresco, MD; Bob Smouse, MD; James Swischuk, MD
Neurointerventional Surgeons
Kenneth Fraser, MD; Sean Meagher, MD
Neurovascular Surgeon
Jeffrey Klopfenstein, MD
Vascular Surgeon
Andy Chiou, MD
Neurovascular Surgery APN
Jan Boerke, APN
Interventional Radiology APNs
Deb Beach, APN; Towana Ernst, APN
For evaluation of potential carotid artery disease, please contact the INI Carotid Clinic at 877-428-2911.
