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Cerebrovascular occlusive disease

Definition

Cerebrovascular occlusive disease occurs when plaque accumulates inside the carotid arteries ― the large arteries in the neck that feed the brain. The condition can cause strokes.

Alternate Names

Carotid atherosclerosis, carotid plaque

Causes, incidence and risk factors

The risk factors for cerebrovascular occlusive disease are similar to those for other arterial plaques, such as those found in the heart arteries (coronary disease) and peripheral arterial disease and include: smoking, genetic history of arterial plaques, hypertension and hypercholesterolemia (high cholesterol).

Types

Cerebrovascular disease can involve all of the blood vessels to the brain, including those inside and outside of the skull. The most common site of plaque build-up is in the carotid artery in the neck.

Signs and symptoms

These plaque build-ups typically do not present any signs or symptoms, but can sometimes cause amaurosis fugax (transient blindness), transient ischemic attacks (TIAs or “mini-strokes”) and stroke.

Tests

The UF Health vascular surgery team has expertise in diagnosing and treating cerebrovascular occlusive disease. Our fully-accredited vascular laboratory provides detailed ultrasounds of carotid arteries. Our full-service radiology department has advanced CT and MRI imaging, which can also be used to evaluate cerebrovascular occlusive disease.

Treatments

Services that to treat cerebrovascular occlusive disease include:

Endarterectomy

This procedure involves removing the plaque in the carotid arteries in an effort to prevent stroke. In patients without symptoms, endarterectomy is usually reserved for patients whose blood flow through the carotid artery is blocked by 70-80% or more, because the stroke risk is quite low below this level of blockage (less than 2% per year).

This operation has been tested over time and proven to decrease the rate of future strokes in certain patients. It involves a small incision in the neck and surgical removal of the plaque from the carotid artery. After removing the plaque, the artery is typically “patched” open with a small portion of bovine pericardium (the lining of a cow’s heart), or a synthetic material such as Dacron.

Some patients are considered high-risk for this procedure due to the location of the plaque, or because of other medical problems, such as heart disease. In these patients, angioplasty and stenting is sometimes considered.

Angioplasty and stenting

Surgeons perform angioplasty and stenting using X-ray imaging by placing a small wire (usually through the femoral artery in the groin) across the blockage in the artery. A small filtering device called an “embolic protection device” is placed past the blockage to prevent showering of plaque to the brain during the procedure.

The blockage is then treated with stent placement followed by balloon angioplasty to fully open the stent within the blockage.

The stent is specially designed for the carotid artery and is a small cylindrical tube made of metal mesh that holds the artery open after treatment. The catheters and wires are then removed along with the filter device and the arterial puncture site in the groin is treated with a closure device to prevent bleeding.

Because of a slightly higher stroke risk with angioplasty and stent treatment, this procedure is typically reserved for patients who are considered high-risk for carotid endarterectomy. Patients may be considered high-risk for endarterectomy for a number of reasons, including their arterial anatomy or their other medical issues, such as heart disease.

Expectations (prognosis)

The timing and type of treatment of cerebrovascular occlusive disease is complex and considerations of whether to proceed with treatment involve many factors, including the degree of blockage, presence or absence of symptoms and the presence of other medical problems. Your surgeon will discuss with you the risks and benefits of treatment and the data that exists regarding the outcomes of these procedures. In general, the complication rate for carotid endarterectomy and stenting is low and the prognosis is very good.

The most important factors in improving long-term prognosis involve decreasing the risk factors associated with cerebrovascular occlusive disease. All patients with cerebrovascular disease should immediately stop smoking, and should be on several medications that are known to decrease overall cardiovascular complications before and after treatment of cerebrovascular disease. These medications include: a statin medication (even if your cholesterol is not high), medications to adequately treat high blood pressure (including a beta-blocker and/or a drug called an ACE Inhibitor), and an anti-platelet drug (such as aspirin, Aggrenox or Plavix).

If you are an active smoker, please discuss quitting with your surgeon, as this is the most serious risk factor associated with cerebrovascular disease. The vascular surgeons at UF Health have an active smoking cessation program and are experts at helping patients successfully quit.

When to call your health care provider

Symptoms such as transient blindness in one eye, mini-strokes or strokes are often related to cerebrovascular occlusive disease and should be reported immediately to your health care provider.

Prevention

Prevention of cerebrovascular occlusive disease involves decreasing the risk factors associated with this problem. These risk factors include smoking, high blood pressure and high cholesterol. Patients with known cerebrovascular disease, or any atherosclerotic plaques such as peripheral arterial disease or coronary artery disease, should be on medications to lower their cholesterol (even if the cholesterol level is not abnormally high), and should be on an adequate medication regimen to normalize their blood pressure. They should also take a daily aspirin or other anti-platelet drug.

Most importantly, if you are an active smoker, this is the biggest risk factor for these conditions and you should seek assistance to quit as soon as possible. The vascular surgeons at UF Health are experts in smoking cessation, and have an active program for helping patients quit.