Arianna Mabunga

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Carotid Artery Disease

Definition

Carotid artery disease occurs when fatty deposits (plaques)

clog the blood vessels that deliver blood to your brain and
head (carotid arteries). The blockage increases your risk of
stroke, a medical emergency that occurs when the blood
supply to the brain is interrupted or seriously reduced.

Carotid artery disease develops slowly. The first sign that you
have the condition may be a stroke or transient ischemic
attack (TIA). A TIA is a temporary shortage of blood flow to
your brain.

Anatomy & Physiology

The carotid arteries are major blood vessels in the neck that
supply blood to the brain, neck, and face. There are two
carotid arteries, one on the right and one on the left. In the
neck, each carotid artery branches into two divisions: The
internal carotid artery supplies blood to the brain.

Etiology

Buildup of plaques in arteries that deliver blood to your brain

Risk factors:

 High blood pressure. Excess pressure on artery walls can weaken them and make them more
vulnerable to damage.
 Tobacco use. Nicotine can irritate the inner lining of your arteries. Smoking also increases your
heart rate and blood pressure.
 Diabetes. Diabetes lowers your ability to process fats efficiently, placing you at greater risk of
high blood pressure and atherosclerosis.
 High blood-fat levels. High levels of low-density lipoprotein cholesterol and high levels of
triglycerides, a blood fat, encourage the accumulation of plaques.
 Family history. Your risk of carotid artery disease is higher if a relative has atherosclerosis or
coronary artery disease.
 Age. Arteries become less flexible and more prone to injury with age.
  Obesity. Excess weight increases your chances of high blood pressure, atherosclerosis and
diabetes.
 Sleep apnea. Spells of stopping breathing at night may increase your risk of stroke.
 Lack of exercise. It contributes to conditions that damage your arteries, including high blood
pressure, diabetes and obesity.

Signs and Symptoms

 Sudden numbness or weakness in the face or limbs, often on only one side of the body
 Sudden trouble speaking and understanding
 Sudden trouble seeing in one or both eyes
 Sudden dizziness or loss of balance
 Sudden, severe headache with no known cause

Pathophysiology
Diagnostic tests

1. Carotid Ultrasound
Carotid ultrasound (also called sonography) is the most common test for diagnosing carotid
artery disease. It's a painless, harmless test that uses sound waves to create pictures of the
insides of your carotid arteries. This test can show whether plaque has narrowed your carotid
arteries and how narrow they are.
2. Carotid Angiography
Carotid angiography is a special type of x ray. This test may be used if the ultrasound results are
unclear or don't give your doctor enough information.
3. Magnetic Resonance Angiography
Magnetic resonance angiography (MRA) uses a large magnet and radio waves to take pictures of
your carotid arteries. Your doctor can see these pictures on a computer screen.
4. Computed Tomography Angiography
Computed tomography (to-MOG-rah-fee) angiography, or CT angiography, takes x-ray pictures
of the body from many angles. A computer combines the pictures into two- and three-
dimensional images.

Medications

Medicines to prevent blood clots are the mainstay treatment for people who have carotid artery
disease. They prevent platelets from clumping together and forming blood clots in your carotid arteries,
which can lead to a stroke. Two common medications are:

 Aspirin
 Clopidogrel

Treatment/Surgery

1. Carotid endarterectomy
 This surgery is done to restore normal blood flow to the brain to
prevent a stroke if you already have symptoms of reduced blood flow.
Carotid endarterectomy also may be performed preventively if a
diagnostic test such as carotid ultrasound shows significant blockage
that is likely to trigger a stroke.
2. Carotid Artery Angioplasty and Stenting
 A thin tube with a deflated balloon on the
end is threaded through a blood vessel in
your neck to the narrowed or blocked
carotid artery. Once in place, the balloon is
inflated to push the plaque outward against
the wall of the artery.
  A stent (a small mesh tube) is then put in the artery to support the inner artery wall. The stent
also helps prevent the artery from becoming narrowed or blocked again

NCP

N
E
ASSESSMEN INTERVENTIO
DIAGNOSIS E PLANNING EVALUATION
T N
D
S
Headache Acute Pain Short Term: 1. Monitor Short Term:
Grimaced face related to C Within 1 hour of Vital Signs Within 1 hour of
High Pain scale increased O nursing nursing
Throbbing pain cerebral G intervention the RATIONALE: intervention the
vascular N
patient will have Monitoring patient had
pressure. I
T
improved comfort vital signs improved comfort
Rationale: I in chest as allows the in chest as
Pain is present V evidenced by: nurse to obtain evidenced by:
when any E  Decreased baseline data  Decreased
tissue in the rating of and is helpful rating of
body is starved P pain (4- in evaluating pain (4/10)
of oxygen-rich E effectiveness
blood, As R 0/10)  Is able to
of therapy
cerebral blood C  Able to rest
pressure E rest 2. Allow the comfortabl
increases there P
comfortabl patient to rest y
is a congestion T
in one or more U y RATIONALE: and
of A and Minimizes displays
veins/arteries L displays reduced
stimulation
that supplies P reduced tension
blood to the A and promotes Goal was met.
tension
cerebrum. T relaxation.
T Long Term: Long Term:
REFERENCES E 3. Maintain a The patient had
Within 2 days of
: R quiet and calm an improved
Doenges, M. N nursing care the
patient will have environment. feeling of control
E., Moorhouse,
M. F., &Murr, an improved as evidenced by
feeling of control RATIONALE: verbalizing a
A. C. (2016).
Nurse’s pocket as evidenced by May aid in the sense of control
guide: verbalizing a reduction of over present
Diagnoses, sense of control tension and situation and
prioritized over present discomfort that future outcomes
interventions, situation and is intensified within 2 days of
and rationales. future outcomes by stress. nursing
FA Davis. interventions.
4. Administer Goal was met.
analgesics as
ordered by the
physician
RATIONALE:
Reduce or
control pain
and decrease
stimulation of
the
sympathetic
nervous
system.

5. Assist
patient with
ambulation as
needed.
RATIONALE:
Dizziness and
blurred vision
frequently are
associated
with vascular
headache.

6. Educate the
patient about
proper diet
and healthy
life style.

RATIONALE:
Proper diet
and healthy
life style helps
control
hypertension.

7. Educate the
patient about
the importance
 of taking
prescribed
maintenance
medications
regularly.
RATIONALE:
Ant-
hypertensives
help control
blood pressure
levels and
reduce risk of
further
complications.

Prognosis

For good prognosis the doctor recommends:

 Quit smoking and using tobacco products.

 Control high blood pressure, cholesterol, diabetes, and heart disease.
 Have regular checkups with your doctor.
 Have your doctor check your lipid profile and get treatment, if necessary to reach a lipid goal of
LDL less than 100 and HDL greater than 45 (your doctor may adjust these goals based on
additional risk factors and/or medical history).
 Eat foods low in saturated fats, cholesterol, and sodium.
 Achieve and maintain a desirable weight.
 Exercise regularly - at least 30 minutes of exercise most days of the week.
 Limit the amount of alcohol you drink. Excessive alcohol use is defined as drinking more than
three drinks per day. (One drink equals 12 ounces of beer or wine cooler, 5 ounces of wine, or
1.5 ounces of 80-proof liquor.)
 Manage other risk factors

If left untreated can lead to stroke through:

Reduced blood flow. A carotid artery may become so narrowed by atherosclerosis that not enough
blood is able to reach portions of your brain.

Ruptured plaques. A piece of a plaque may break off and flow to smaller arteries in your brain. The
plaque fragment may get stuck in one of these smaller arteries, creating a blockage that cuts off blood
supply to part of your brain.

Blood clot blockage. Some plaques are prone to cracking and forming irregular surfaces on the artery
wall. Your body reacts as if to an injury and sends blood cells that help the clotting process to the area.
The result can be a large clot that blocks or slows blood flow to the brain, causing a stroke.
References:

Carotid artery disease - Symptoms and causes. (2018, October 4). Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/carotid-artery-disease/symptoms-causes/syc-
20360519

Carotid artery disease: MedlinePlus medical encyclopedia. (2016). MedlinePlus - Health Information from
the National Library of Medicine. https://medlineplus.gov/ency/article/007427.htm