The Relationship Between Carotid Plaque, Atherosclerosis and Stroke


One of the major dangers in patients with atherosclerosis is the formation of a carotid plaque and subsequent occurrence of a stroke. The carotid artery is one of the most common areas for plaques to form, and the effects of a stroke are severe and permanent.


Carotid Plaque, Atherosclerosis and Stroke

How Does Carotid Plaque Relate to Atherosclerosis?


Atherosclerosis is a condition in which the walls of arterial vessels thicken due to the accumulation of fatty deposits. Cholesterol and trigylcerides are the primary components in these deposits, referred to as plaques. Deposits that form in the main arteries feeding the brain are carotid plaques. The carotid arteries, one on each side of the neck, extend from the aorta to the face and brain. Among patients with atherosclerosis, these arteries are a common site for the accumulation of plaque. This accumulation is a type of carotid artery stenosis, the latter being a blanket term that refers to any type of vascular narrowing.


How Does Carotid Artery Stenosis Relate to Stroke?


Carotid artery stenosis caused by atherosclerosis is sometimes asymptomatic, particularly in early stages when the blockage is not severe. Commonly, severe plaque formation leads to strokes or stroke-like events called transient ischemic attacks. When a plaque is stable, there are no symptoms. However, if emboli break off the plaque and travel downstream into the brain, symptoms occur. Small emboli sometimes get stuck in brain vessels temporarily, leading to attacks with contralateral symptoms such as numbness, tingling, weakness or even paralysis. Emboli that get permanently stuck cause strokes with similar symptoms that do not resolve, and sometimes lead to death.


BY THE NUMBERS

It is critical that patients with carotid plaque or atherosclerosis monitor for signs of a transient ischemic attack. According to the National Stroke Associate, 5 percent of individuals who experience an attack have a stroke within two days. Within three months, 10 to 15 percent have a stroke.


How Is Carotid Plaque Diagnosed?


Often, carotid plaque is completely asymptomatic until an emboli breaks off and results in a transient ischemic attack or stroke. Many individuals relate symptoms of an attack to doctors, and the diagnostic process reveals the carotid stenosis. Other patients suffer a stroke, and doctors later determine the cause of the blockage as a build-up of carotid plaque. No matter the circumstances, doctors detect carotid plaque in a few common methods. Because the carotid arteries lie close to the skin, listening with a Doppler device yields information about blood flow and potential stenosis. Doctors confirm the diagnosis with color flow duplex ultrasound scans. This step is usually sufficient for diagnosis, but occasionally doctors must use a CT or MRI angiogram.


What Are Treatments for Carotid Plaque?


It is critical that individuals undergo treatment to remove carotid plaque stenosis in order to prevent stroke. This is especially true following a transient ischemic attack because many attacks are precursors to severe strokes that occur within 48 hours. Doctors often choose to treat asymptomatic patients with antiplatelet drugs and lifestyle changes. For those patients who do experience an attack or stroke, the treatment of choice is surgical. One treatment, a carotid endarterectomy, involves opening the carotid artery and scraping out the plaque. An alternative, carotid stenting, uses a catheter to place a stent in the artery that opens the site of the stenosis. Both procedures are effective, though stenting tends carry more risk for side effects.


Patients with atherosclerosis must take great care to monitor for signs of transient ischemic attacks in order to avoid a stroke. Taking all prescribed medications and adhering to recommended lifestyle changes is critical to prevent further build-up of carotid plaques.


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