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Carotid Artery Disease

Carotid Artery Disease

The Vascular Surgery team at the University of Michigan is dedicated to providing exceptional patient care for cerebrovascular disease in the U-M Cardiovascular Center (CVC), our new state-of-the-art clinical building.

Our surgeons have extensive experience in the management of cerebrovascular disease and offer unique expertise in the two alternatives that exist today for the correction of carotid lesions: carotid endarterectomy and angioplasty and stent placement. In our collaborative environment, we are constantly seeking improved treatments for vascular disease. In the area of carotid stenting, Enrique Criado, M.D., has developed a reverse flow stenting system that dramatically decreases the probability of embolization during stent placement. Ramon Berguer, M.D., has pioneered new surgical techniques for the reconstruction of complex carotid disease and vertebral arteries that are now used worldwide.

What is Carotid Artery Disease?

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Carotid artery disease is a form of cerebrovascular disease, the third-leading cause of death in the United States. Cerebrovascular disease occurs when the blood vessels supplying the brain with oxygenated blood are damaged or their function is compromised. This condition is caused by a blockage or a fragment of plaque impacting an artery of the brain. If blood flow is severely restricted, the brain does not receive adequate oxygen and a stroke can occur. In 2007, about 700,000 people suffered a new or recurrent stroke in the United States.

Carotid Artery Disease

The carotid arteries are large blood vessels on each side of the neck that carry oxygen-rich blood to the front structures in the brain that control thinking, speech, sensory and motor functions. These arteries, like others in the human body, can become thickened and lose their elasticity. Plaque builds up on the inside wall of the vessel, blocking blood flow to the brain. This condition, atherosclerosis, is often referred to as "hardening of the arteries." If this blockage is severe enough, it can cause symptoms such as:

  • Weakness or numbness on one side of the body
  • Loss of coordination
  • Blindness in one eye or blurred vision
  • Difficulty speaking
  • Severe dizziness

It is important to tell your health care provider if you have had temporary problems with vision or minor paralysis. A routine physical exam usually detects carotid artery disease, even if you have no symptoms. Your provider may hear a murmur, called a "bruit", by listening to the carotid artery in your neck with a stethoscope. The murmur is caused by blood rushing through a narrowed part of the artery.

Testing for Carotid Disease

Although there are a number of possible treatments for Carotid Artery Disease, the first step is testing. Screening for carotid disease is done easily and quickly with an ultrasound scan. There is no risk with this study and no discomfort. If you have any of the symptoms mentioned earlier, your doctor will most likely order this scan. Pending those results, your physician may suggest medication adjustments for your blood pressure or cholesterol level, and will certainly suggest you quit smoking, if you do.

From the results of this screening, your physician will recommend a course of treatment. If you have only a moderate blockage of the artery but no symptoms, you may be treated with drugs. Your health care provider may prescribe medicine that thins the blood or prevents blood clots. If your blockage is severe (70-99%) you will likely benefit from surgery.

If you have symptoms, your doctor may order a cerebral arteriogram or a CTA to determine the exact site of blockage or to rule out additional blockages upstream or downstream of the plaque at the carotid bifurcation. Surgery or a carotid stent will be recommended to patients with symptoms that can be attributed to known plaque in the carotid artery.

About the Tests

  • Cerebral arteriogram - an x-ray dye procedure that shows how narrow the inside of the artery is and the exact location of the blockage.

  • CT scan (computerized x-rays) of the head - uses x-rays to outline the brain structures to rule out a recent stroke.

  • CTA (CT angiogram) - shows the lumen of the arteries marked with dye.

  • MRI (magnetic resonance imaging) - uses magnetism, radio waves, and a computer to make pictures that can show plugged blood vessels.

  • Ultrasound - shows how large the blockage is and the amount of blood flowing through the artery.

Surgical Treatment for Carotid Disease

If it is determined that surgical treatment for carotid disease is necessary, our surgeons are equipped to perform the most advanced procedures, some of which were developed right here at the University of Michigan. Follow the links below to learn more about surgical treatment options.

Make an appointment or contact us for more information.