The brain receives its blood supply from two sets of arteries. The carotid arteries travel up the front of the neck and supply the front part of the brain where speech, personality, thinking, sensory, and motor functions are located. The vertebral arteries run through the spine and supply blood to the back of the brain—the brainstem and cerebellum.
Extracranial vascular disease refers to atherosclerosis, which is a hardening and narrowing of the walls of these vessels, due to deposits of fats that form plaques within the arteries. As the plaque deposits gradually enlarge, they interfere with blood flow. Atherosclerosis can affect any large-to-medium-sized artery in the body and cause serious health problems. It is especially dangerous in the extracranial arteries that supply the brain, as decreased blood flow to the brain can result in stroke.
At UPMC, extracranial vascular disease may be treated medically or surgically, depending upon the severity of the disease.
Diagnosis begins with an assessment of symptoms, a thorough patient history, and a physical exam. If extracranial vascular disease is suspected, arteriography is the test of choice to either confirm or exclude the presence of this condition.
There may be no signs of carotid artery disease prior to stroke. However, some people experience warning symptoms of a stroke called a transient ischemic attack (TIA). Such symptoms include:
- weakness or numbness on one side of the body
- difficulty speaking or understanding speech
- sudden, severe headache
- changes in vision
A transient ischemic attack should be treated as a medical emergency, even if the symptoms go away. Transient ischemic attacks are often warning signs of an imminent stroke.
Symptoms of vertebral artery disease overlap with those of carotid artery disease and may include:
- double vision
- numbness around the mouth
- tinnitus (ringing in the ears)
- difficulty speaking
- partial blindness
Most patients with atherosclerosis are given an antiticoagulant to prevent blood clots. Surgery may be needed, depending on the degree of blockage within the arteries that supply blood to the brain. UPMC has one of the country's leading neuroendovascular surgery programs. This multidisciplinary program includes neurosurgeons, neurologists, cardiologists, and radiologists.
There are situations where an open cervical approach may be indicated, which is called endarterectomy. This surgical procedure consists of a small linear incision in the neck followed by dissection and localization of the carotid artery. The artery is opened and all the "calcified fat" (atheroma) is removed from the artery to reestablish flow and avoid strokes. The brain waves are monitored during surgery to make sure the brain is receiving enough blood throughout the procedure.
At UPMC, we take a 360° Approach to treatment when evaluating each patient—looking at their conditions from every direction—to find the path that is least disruptive to the patient’s brain, critical nerves, and ability to return to normal functioning. Our neurosurgical team may recommend a combination of surgical and non-surgical approaches to maximize the benefits of surgery while minimizing risks.