Clearing The Carotid

How to treat plaque buildup in two major blood vessels

If you’re a fan of TV medical or detective dramas, you’ve probably heard a character mention the carotid arteries once or twice. What makes these vessels important enough for prime time? They are the big arteries that bring oxygen-rich blood to your brain, face and neck.

“The carotid arteries are major blood vessels that divide into two branches at the level of your neck,” explains vascular surgeon Kristy Conlon, DO, RPVI, of St. Joseph’s/Candler’s Physician Network – Vascular Specialists. “These vessels then branch out even more to carry blood throughout your face, brain and head.”

When these vessels become narrowed from a buildup of plaque, this is called carotid artery stenosis, also known as carotid artery disease. It is one of the leading risk factors for stroke. Medications and lifestyle changes can help you manage carotid artery stenosis, but some patients may need surgery.

“As a vascular surgeon, it’s very satisfying to take the plaque out,” Dr. Conlon says. “Some of the patients I treat aren’t really aware of how narrow their arteries have become because they aren’t experiencing symptoms.”

Everyone Gets Plaque

Though your lifestyle can affect how much plaque builds up in your blood vessels, the fact is that everyone will accumulate some plaque in their lifetime.

“You develop plaque over time, and the older you get, the more common it is,” Dr. Conlon says. “People with high cholesterol or high blood pressure will get more plaque than others. There is also more buildup in those who also have diabetes, those who smoke and those who lead sedentary lives.”

Plaque is made up of substances that circulate in your blood such as cholesterol, proteins and calcium. Not all plaque buildup will lead to carotid artery stenosis, but the risk gets higher as you age. If plaque in the carotid arteries becomes loose, it can flow downstream and block blood flow to the brain. In other cases, though less common, the plaque can severely slow the blood flow, depriving the brain of oxygen and quickly leading to cell death.

In its early stages, however, carotid artery stenosis may not cause symptoms.

“A primary care physician may discover the stenosis during a routine checkup,” Dr. Conlon says. “Your neck pulse makes a distinctive sound when there is narrowing of the artery.”

Unfortunately, for many patients the first sign of the disease is a stroke or a transient ischemic attack, or TIA, also known as a mini-stroke.

Symptoms of TIA are the same as a stroke, which means the BE FAST system can help you identify a TIA quickly:

B – Balance (a sudden change in coordination and balance)

E – Eyes (a sudden change in vision, such as cloudy vision)

F – Facial drooping

A – Arm drifting, weakness or numbness

S – Speech is slurred or garbled or there’s an inability to speak at all

T – Time to call 9-1-1 immediately

If plaque in your carotid arteries causes a TIA, you will likely need surgery. The American Stroke Association says that 9 to 17 percent of people who have had a TIA suffer from a stroke within 90 days.

A Better State Of Flow

For patients who need surgery, Dr. Conlon will most often perform a carotid endarterectomy. This is the gold standard for treating carotid artery stenosis. In this procedure, the surgeon makes an incision in the neck, opens the carotid artery and removes the plaque. The cleared artery is then closed with a patch from either synthetic material or from another one of your blood vessels.

“Personally, it’s my favorite operation,” Dr. Conlon says with a smile.

Because it is an open surgery, not all patients are candidates for a carotid endarterectomy. In those cases, Dr. Conlon will place a stent in the clogged artery. The stent is a small metal scaffolding that props the artery open and improves blood flow. This is a less invasive procedure and is a better option for those whose open surgery risk is high.

For both procedures, patients can expect to go home the next day. They must avoid strenuous activity or heavy lifting for at least two weeks. After that, most patients will be able to return to driving and regular daily activities. However, it will still be important to avoid overexertion.

A new part of your life post-surgery will be incorporating lifestyle changes that can help reduce your risk of plaque rebuilding in your carotid arteries. Not surprisingly, those principles are the same that can help prevent severe plaque buildup in the first place.

“Keeping your cholesterol and your blood-glucose levels under control is huge part of vascular health, along with a healthy diet and exercise, of course,” Dr. Conlon says. “It’s important not just for your carotid arteries but for all of your blood vessels.”

St. Joseph's/Candler Physician Network - Vascular Specialists includes the combined experience of Norman Lee Yates III, MD, Kristy Conlon, DO, RPVI, and Peter J. Hunt, MD, RPVI. Our physicians perform a number of procedures specializing in the vascular system and use the latest technology to improve your quality of life. Call 912-354-8331 to learn more.