History of Carotid Stenosis
In 1875, we came to understand that a stroke was most likely caused from outside of the skull – no intracranial. The first carotid endarterectomy was performed in 1953. Extracranial, or outside the skull causes are the top preventable sources of stroke including the carotid artery, hypertension, and atrial fibrillation.
Why see your primary care physician yearly?
Hypertension – Control of high blood pressure appears to be the number one medical treatment that can help decrease the chances of having a stroke.
Cholesterol – statistically there is a positive effect on stroke with the use of hypercholesterol medication. The exact pathophysiology or effect of the disease is not well understood.
Smoking – cigarette smoking is an obvious statistical risk factor for all cardiovascular diseases.
Carotid Stenosis Risks Factors
Atrial Fibrillation: uncontrolled or untreated atrial fibrillation has a greatly increased risk of stroke.
Gender: men appear to have more strokes than women, but women have more fatal complications from a stroke.
Age: the risk of stroke begins to rise significantly after the age of 55.
Race: Blacks and Hispanics are more at risk of having a stroke than whites. The difference is that their strokes are more secondary to hypertension and intracranial disease. Whites have more carotid artery disease.
Family History: any history of cardiovascular disease in the family increases the risk of stroke.
Diabetes: This risk factor actually includes younger patients under the age of 65 more than other risk factors.
Obesity and Diet: Having a BMI of more than 30 and fewer fresh fruits and vegetables in one’s diet has been shown to have an effect on the risk of having a stroke.
Minimal Physical Activity: being active probably affects other risk factors positively including diabetes and obesity.
In the REGARDS study, participants who reported physical activity less than four times a week had a 20% increase in stroke risk…
Will I Need Any Testing?
Carotid Ultrasound is the main diagnostic tool which is minimally invasive. This takes about 45-60 minutes. This can be done in our office for your convenience.
Cat Scan angiogram (CTA) is an imaging test to confirm anatomy and percentage of stenosis. This will also be used to evaluate between options of types of treatments.
MRI angiogram (MRA) is an imaging test to confirm anatomy and percentage of stenosis.
The traditional angiogram procedure is the gold standard for imaging and documentation for carotid stenosis but is not needed as much today.
What are treatment options?
Carotid endarterectomy (CEA) is still the gold standard procedure for treating carotid stenosis disease for adequate-risk patients.
Transcarotid artery revascularization (TCAR) is becoming a good less invasive carotid artery stenosis treatment with similar beneficial results as endarterectomy.
Transfemoral carotid artery stenting (TF-CAS) has indications for symptomatic patients and high-risk patients who are not able to undergo carotid endarterectomy. A review of multiple studies has shown that TF-CAS (predominantly transfemoral route) was associated with significantly higher 30-day rates of stroke, death/stroke, death/disabling stroke, and death/stroke/MI, compared with CEA.
To discuss Stroke prevention, help with a referral or schedule a consultation,
call us at (208) 528-1098
Reference for all above: Rutherford’s Vascular Surgery and Endovascular Therapy, 10th ed.