Cerebrovascular Disease that Increases Stroke Risk

Carotid artery disease is a manifestation of cerebrovascular atherosclerotic disease. It develops when atherosclerotic (fatty) deposits or fatty plaques cause the carotid arteries in your neck to narrow, preventing blood from flowing easily through the artery.

Carotid artery disease can be dangerous, as it impacts the blood supply to the brain and significantly increases your risk of having a stroke or a transient ischemic attack (TIA).

• Stroke: Stroke is the third leading cause of death. Strokes occur when the brain’s blood supply is partly or completely blocked. Most often, strokes occur when a blood clot blocks a blood vessel to the brain. A stroke can also occur when a blood vessel breaks open or leaks. Strokes can cause long-term brain damage and death. About half of stroke patients have long-term problems, although some people who have a stroke recover most or all of their functions.
• Transient ischemic attack (TIA): TIAs occur when a blood clot briefly blocks a blood vessel to the brain. The symptoms are the same as a stroke; however, the symptoms only last a few minutes to a few hours and do not cause permanent damage. TIAs are a warning sign that a full stroke occur in the near future if nothing is done to prevent it.

Symptoms, Diagnosis and Outlook

You may not experience any symptoms in the early stages of carotid artery disease. However, that can quickly change and escalate into a stroke or a transient ischemic attack (TIA). These symptoms include:

• Vision loss
• Weakness in one part of your body
• Difficulty in speaking

At Penn State Health, we are committed to quickly diagnosing you to ensure you’re getting proper stroke care. Your physician will perform a physical exam and may use a stethoscope to listen to the blood flow in your neck. Your physician will be looking for a bruit, an unusual sound that indicates carotid artery disease.

Your physician can also find clots in the blood vessels of your eye. If you have had a stroke or TIA, a nervous system (neurological) exam will show other problems.

Additional tests during your diagnosis:

• Blood cholesterol and triglycerides test
• Blood sugar (glucose) test
• Ultrasound of your carotid arteries (carotid duplex ultrasound) to visualize the blood flowing through your carotid artery

Imaging tests of your neck and brain are also sometimes necessary for diagnostic purposes. At Penn State Health, these tests may include:

• Cerebral angiography
• Carotid artery duplex ultrasound
• Computerized tomographic angiography
• Magnetic resonance angiography

Carotid artery disease can be dangerous because there are no immediate symptoms. You might not know that you have carotid artery disease until you have a stroke or TIA. Strokes are the leading cause of death in the United States. About half of stroke patients have long-term problems, although some people who have a stroke recover most or all of their functions.

Why Choose Penn State Health for Care

Commitment to Research

The Penn State Health Stroke Center has a strong and active research program in stroke and cerebrovascular disease. As the only academic medical center in central Pennsylvania, our vascular surgery and neurosurgery experts are worldwide experts. Our clinical research and medical innovations aim to improve the quality of life for patients and their caregivers by better understanding the basics of cerebrovascular disease and creating new therapies to help the brain repair itself after significant blood loss or loss of blood flow.

Advancing Research in Cerebrovascular Disease

Penn State Health is involved in many clinical and laboratory projects to help improve our care for stroke patients. These projects also aim to develop new therapies for this challenging disease. Research at Penn State Health Stroke Center includes:

• ATTACH trial: researching how tight blood pressure control can treat intracerebral hemorrhage, which is a type of stroke caused by bleeding within the brain tissue
• CLEAR III trial: studying the role of tPA (an enzyme that helps dissolve blood clots) in intraventricular hemorrhage, which is bleeding into fluid-filled areas of the brain
• Pipeline Embolization Device database: leveraging a comprehensive database from many medical centers throughout the U.S. to learn which patients are helped most from a new device that treats aneurysms (brain vessel bulge in the brain)
• Stenting studies: investigating how stenting can treat brain aneurysms and intracranial occlusive disease, which causes a specific type of stroke
• Lab studies: studying two types of strokes – ischemic stroke (where a blood vessel in the brain is blocked by a blood clot) and hemorrhagic stroke (when a weak blood vessel ruptures)
• Radiosurgery studies: researching how a single, focused, high dose of radiation can be used to treat brain aneurysms.
• Retrovirus studies: studying how retroviruses (a virus that comes with its own enzyme) can encourage brain cells to make new brain tissue after a stroke

Learn more about new Penn State Health clinical trials at StudyFinder.

Cutting-Edge Surgical Treatments

If you have carotid artery disease, the Penn State Health Stroke Center offers cutting-edge treatment options with skilled stroke neurologists, vascular surgeons and neurosurgeons. Penn State Health Stroke Center may need to open your artery to improve blood flow. Surgical treatment options for carotid artery disease can include opening up an artery to improve blood with either carotid endarterectomy or carotid angioplasty and stenting (CAS).

Carotid endarterectomy

Carotid endarterectomy is the most common surgery performed to help our patients lower their risk of stroke. The surgery is done to open or clean out your artery to increase blood flow through the carotid artery. It is typically performed under regional anesthesia, which is a numbing shot to keep you relaxed and comfortable. Since you’ll be awake for this surgery, you are not as likely to have heart or lung side effects. Recovery is also faster and you will be able to leave the hospital the next day.

Carotid angioplasty and stenting (CAS)

Carotid angioplasty uses a balloon and a stent (a hollow tube of wire-like mesh) to open a narrow carotid artery from inside your blood vessel. This procedure includes:

• Your surgeon inserting a flexible tube (catheter) into a large artery in your femoral artery, which is in your groin area.
• The surgeon guides the catheter up to the carotid artery in your neck and passes the balloon through the catheter to the blocked part of your artery.
• Once the balloon is in place, your surgeon inflates the balloon to open up the blockage. When the blockage is open, your surgeon will place a stent across the affected area, which will keep the artery wide-open.

CAS surgery is done while you are awake. Recovery time is short and most patients go home the next day.

Transcarotid Artery Revascularization (TCAR)

The most recent innovation in the surgical treatment of carotid artery disease is TCAR, in which carotid artery is exposed to place a stent via carotid artery. This operation is associated with the least risk of stroke of any carotid intervention. Vascular surgeons at the following locations are now offering this new intervention.

• Penn State Health Milton S. Hershey Medical Center 
• Penn State Health St. Joseph Medical Center
• Penn State Health Lancaster Medical Center 
• Penn State Health Holy Spirit Medical Center

Support Groups

Support groups provide an opportunity to share your feelings and connect with other patients and caregivers who are experiencing similar struggles.

Learn more about support groups offered