The carotid arteries are the blood vessels that connect the aorta (principal artery leaving the heart) with the brain. Certain portions of the carotid arteries have a predilection for disease formation. The significance of this disease is that about one-third of all strokes arise from carotid artery disease. Small pieces or plaque or clot can break away from the site of disease and travel to a small vessel in the brain, thereby depriving that area of oxygen and nutrients. Unless the blockage is very rapidly resolved, a stroke will occur.

Carotid artery disease is almost always the result of atherosclerosis. Factors promoting disease in the carotid arteries are smoking, hypertension, diabetes and elevated cholesterol. The disease most commonly progresses from a small plaque to one that can completely occlude the vessel. Problems do not typically occur until the vessel is at least 80% blocked.

Carotid artery disease may be asymptomatic and discovered during routine physical exam by the presence of an abnormal sound in the neck. Alternatively, its’ presence may first be identified when evaluation for certain neurological conditions such as stroke, temporary neurological symptoms (a Transient Ischemic Attack) or sudden vision loss.

Duplex ultrasonography is a very good way to evaluate for carotid artery disease. The method is painless and uses ultrasound waves to form a two dimensional picture of the artery and an analysis of the blood flow velocity to quantify degree of blockage. While ultrasound has for the most part replaced contrast arteriography (catheterization), this latter modality is still employed in selected situations. The newest modality, computed tomographic arteriography, may prove to be the best modality of all.

Following the diagnosis of carotid artery disease, surgical evaluation may be in order. Significant symptomatic disease is almost always treated surgically, as the benefits achieved in prevention of future neurological events far exceeds the risks. When the disease is asymptomatic, surgical treatment may be recommended based on each person’s individual features.

Surgery for carotid artery disease is one of the most common and successful vascular operations performed. Since the disease is localized to one segment, opening the vessel and removing the inner diseased portion can be done safely. The operation is most often performed using local anesthesia and sedation, rather than general anesthesia, and takes about one hour to complete. Hospitalization is usually overnight and return to normal activities is very swift.

Whether operation is appropriate for you is an individualized decision that only can be reached after a thorough discussion of the natural history of the disease, your individual medical conditions, and the risks of operation. Your surgeon is uniquely able to carry on such a discussion.