St. Joseph Hospital of Orange
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Carotid Artery Stenosis

Coronary Artery Disease (CAD) causes a decrease in blood flow to the heart muscle. When fatty substances called plaque are deposited in the inner lining of an artery, the artery is narrowed, restricting or blocking blood flow. The rupture of this plaque can cause a heart attack and subsequent chest pain.

Risk Factors

The more risk factors a person has for CAD, the more likely it is that the person will develop heart problems or have a heart attack. Risk factors for CAD include:

  • Being a man older than age 35.
  • Being a woman who has gone through menopause.
  • Being overweight.
  • Having high blood pressure (hypertension).
  • Having diabetes.
  • Having high cholesterol.
  • Having a family history of heart disease.
  • Smoking cigarettes.
  • Being physically inactive.
  • Risk factors for a heart attack also include the use of cocaine and amphetamines.

Diagnosis

After you have described your symptoms and your physician has performed a physical examination, any one of several diagnostic tests may be ordered to diagnose and determine the severity of the coronary artery disease or heart attack and your current heart health. These diagnostic procedures may include an electrocardiogram, an exercise stress test or cardiac catheterization.

Treatment

Carotid artery stenosis (or narrowing of the carotid artery) can be treated in the Interventional Radiology department for patients who meet the criteria for this non-surgical procedure. Those patients who may be candidates for the procedure are identified by the Vascular Institute physicians after completion of the same diagnostic studies that are required for surgical carotid intervention (duplex ultrasound, CT or MRI imaging and carotid angiogram dye study) has occurred. Most patients with carotid stenosis have atherosclerosis (hardening of the arteries) that can cause the buildup of plaque (combination of cholesterol, calcium and fibrous tissue) and the narrowing and stiffening of the carotid arteries. Opening of the carotid artery is achieved by the Interventional Radiologist performing angioplasty, which allows a small balloon to flatten the plaque against the artery wall and widen the space where the blood flows through. A slender metal-mesh tube, called a stent, is placed inside the carotid artery after angioplasty to keep the artery open and increase blood flow to the previously blocked area. The stent is left in place and patients are placed on medication (platelet inhibitors) to prevent future collection of blood cells where the previous plaque build-up occurred. The procedure is done while the patient is awake, with light sedation. The patient remains in the hospital overnight for observation of any potential neurological changes after the procedure.

Outcomes

Although angioplasty and stenting for carotid artery stenosis opens and keeps the blood flowing, it does not stop plaque from building up. Patients are encouraged to consider changes in their lifestyle to decrease the risk factors contributing to atherosclerosis and to have follow-up by their primary physicians, neurologist and Vascular Institute physician if symptoms reoccur. This includes diet control, regular exercise, maintaining ideal body weight, smoking cessation and recommendations to control cholesterol levels and/or blood sugar levels for diabetic patients.