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Kenneth Goldstein, MD
Q. What causes carotid artery disease?
A. Carotid artery disease (CAD) occurs when plaque builds up and clogs the carotid arteries that deliver blood to your head and brain. It occurs in about 3 percent of people aged 65 and older, according to the Society for Vascular Surgery.CAD is caused by atherosclerosis, a collection of fatty substances and cholesterol (“hardening of the arteries”) and restricts blood flow. If plaque breaks off, it can be carried to the brain and lead to a stroke.
Q. What are the symptoms of CAD and who is at greatest risk? How is it diagnosed?
A. CAD is mostly asymptomatic, and is usually found when a physician hears a Bruit (a vascular murmur). Bruits may indicate partial obstruction or location-specific high rate of blood flow. Your physician may recommend testing if you are symptomatic for other vascular diseases, or if you have risk factors, such as smoking, diabetes, high cholesterol, high blood pressure, age, and a family history of vascular disease.An initial ultrasound screening requires no radiation or dye. If test results are positive, further testing may be warranted. Risk factor moderation is the next step: Stop smoking. Reduce cholesterol. Your doctor may prescribe aspirin or anti-platelet medications. If narrowing becomes more severe, a referral to a vascular surgeon should be made to discuss possible interventions.
Q. What treatments are available and is there anything new on the horizon?
A. Tiered treatment options are based on severity and you should discuss the procedures with your physician.Carotid endarterectomy (CEA) removes arterial plaque to restore proper blood flow. A small neck incision is made and the artery is opened, cleaned out and patched. Patients may undergo a CEA while awake or under general anesthesia, and brain function is continuously monitored. Arteries are clamped surrounding the blockage to prevent plaque traveling to the brain during the procedure.During carotid stenting, a catheter is threaded through the arteries to the narrowed carotid artery and an inserted stent (metal mesh tube) prevents narrowing.Northwell Health is one of the few New York locations where an innovative procedure, transcarotid artery revascularation (TCAR), is performed. It uses a much smaller incision than a CEA and offers faster recovery time. A small sheath placed into the carotid artery is connected to a blood flow reversal device to decrease the risk of embolic stroke. Blood is filtered outside the body to capture plaque before blood re-enters the body. Following stent placement, a tiny, inflated balloon opens the blockage and separates the plaque particles. Once TCAR is completed, the stent keeps the artery open and normal blood flow resumes.
Q. What are the biggest misconceptions people have about carotid artery disease and what surprises them most about treatment and recovery?
A. People are surprised it’s treatable and, once diagnosed, they can reduce their risks. If the disease doesn’t progress, chances are good you won’t need a surgical intervention.If surgery is needed, it’s very well tolerated. Most people only require a 24-hour hospital stay and get better quickly.
Learn More About Dr. Goldstein
Chief, Vascular Surgery
Northern Westchester Hospital
Northern Westchester Hospital is a proud member of Northwell Health.
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