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Carotid Arterial Disease: Education and Treatment - Carotid Endarectomy vs Carotid Stent - Cleveland Area Based Vascular Solutions

Carotid Arterial Disease - Diagnosis, Education and Treatment Options for prevention of stroke

The blood supply to the brain is derived from four blood vessels. The front (anterior) 2/3 of the brain is supplied by a right and left carotid system that arises from the aortic arch close to the heart. The back (posterior) 1/3 of the brain is supplied by the right and left vertebral arteries that fuse together close to the brain to form one larger, single blood vessel know as the basilar artery. Although blockages of the vertebral arteries is not rare, it does not typically produce symptoms since the two arteries in the process of fusing together provide adequate supply in the face of a shortage from a single vessel blockage. On the other hand, the blood circulation in the front portion of the brain is more directly dependent on the direct supply of the respective carotid arteries. The common carotid artery divides into an external carotid artery, which supplies the face and the internal carotid artery, which supplies the front of the brain. The external carotid artery is not important.

Strokes are caused by small clots and particles released from a source that travels into the small blood vessels in the brain. If a blood vessel in the brain becomes blocked, blood supply consisting of oxygen and nutrients can not be delivered. If the duration of the blockage is short, the neurologic symptoms may be temporary and are often called a transient ischemic attack (TIA). If the blockage occurs for a long enough time, then it is called a stroke or brain attack.

The most common source for a TIA or stroke is the carotid arteries but it can also occur because of heart disease. The right side of the brain controls the left side of the body and the left side of the brain conversely controls the right side of the body. Additionally, the left side of the brain controls language for both understanding and communication. If the left internal carotid artery is the source for a stroke, it would result in a left brain or hemispheric brain attack and manifest by the inability to move the right arm or leg or perhaps the inability to speak or understand the spoken word.

If the internal carotid artery develops a narrowing that exceeds 50% it can become responsible for release of clots or particles that can result in a stroke. Risk factors leading to the narrowing in the carotid artery or atherosclerosis include smoking, hypertension, diabetes, high cholesterol and lipid levels, obesity, and hyperhomocyteinemia.

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