• Carotid Pulse Site Definition
• When Is The Carotid Pulse Site Used
• Carotid Pulse Site Meaning

The normal carotid pulse is felt in systole, after the first heart sound is heard, and before the second heart sound is heard. Click to see full answer Similarly, which heart sound coincides with pulse? S1 is normally a single sound because mitral and tricuspid valve closure occurs almost simultaneously. To check your pulse using this method, you’ll be finding the radial artery.

Overview

What are the carotid arteries?

Arteries carry oxygen-rich blood away from the heart to the head and body. There are two carotid arteries (one on each side of the neck) that supply blood to the brain. The carotid arteries can be felt on each side of the lower neck, immediately below the angle of the jaw.

The carotid arteries supply blood to the large, front part of the brain, where thinking, speech, personality and sensory and motor functions reside.

The vertebral arteries run through the spine and supply blood to the back part of the brain (the brainstem and cerebellum).

What is carotid artery disease?

Carotid artery disease, also called carotid artery stenosis, is the narrowing of the carotid arteries, usually caused by atherosclerosis. Atherosclerosis is the buildup of cholesterol, fat and other substances traveling through the bloodstream, such as inflammatory cells, cellular waste products, proteins and calcium. These substances stick to the blood vessel walls over time as people age, and combine to form a material called plaque.

Plaque buildup can lead to narrowing or blockage in the carotid artery which, when significant, can put an individual at increased risk for stroke.

Symptoms and Causes

What are the symptoms?

There may not be any symptoms of carotid artery disease. However, there are warning signs of a stroke. A transient ischemic attack (also called TIA or 'mini-stroke') is one of the most important warning signs of a stroke. A TIA occurs when a blood clot briefly blocks an artery that supplies blood to the brain. The following symptoms of a TIA, which are temporary and may last a few minutes or a few hours, can occur alone or in combination:

• Sudden loss of vision or blurred vision in one or both eyes
• Weakness and/or numbness on one side of the face, or in one arm or leg, or one side of the body
• Slurred speech, difficulty talking or understanding what others are saying
• Loss of coordination
• Dizziness or confusion
• Difficulty swallowing

A TIA is a medical emergency, since it is impossible to predict if it will progress into a major stroke. If you or someone you know experiences these symptoms, get emergency help (Call 9-1-1 in most areas). Immediate treatment can save your life or increase your chance of a full recovery.

TIAs are strong predictors of future strokes; a person who has experienced a TIA is 10 times more likely to suffer a major stroke than someone who has not experienced a TIA.

What is a stroke?

A stroke, or 'brain attack,' occurs when a blood vessel in the brain becomes blocked or bursts. The brain cannot store oxygen, so it relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke results in a lack of blood supply, causing surrounding nerve cells to be cut off from their supply of nutrients and oxygen. When tissue is cut off from its supply of oxygen for more than 3 to 4 minutes, it begins to die.

A stroke can occur if:

• The artery becomes extremely narrowed by plaque
• A piece of plaque breaks off and travels to the smaller arteries of the brain
• A blood clot forms and blocks a narrowed artery

A stroke also can occur as a result of other conditions, such as sudden bleeding in the brain (intracerebral hemorrhage), sudden bleeding in the spinal fluid space (subarachnoid hemorrhage), atrial fibrillation, cardiomyopathy, or blockage of the tiny arteries inside the brain.

Diagnosis and Tests

How is carotid artery disease diagnosed?

There may not be any symptoms of carotid artery disease. If you are at risk, it is important to have regular physical exams.

A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (pronounced BROO-ee), may indicate carotid artery disease. However, bruits are not always present when there are blockages, and may be heard even when the blockage is minor.

Diagnostic tests include:

• Carotid duplex ultrasound: An imaging procedure that uses high-frequency sound waves to view the carotid arteries to determine if there is narrowing. This is the most common test utilized to evaluate for the presence of carotid artery disease.
• Carotid angiography(carotid angiogram, carotid arteriogram, carotid angio): During this invasive imaging procedure, a catheter (thin, flexible tube) is inserted into a blood vessel in the arm or leg, and guided to the carotid arteries with the aid of a special X-ray machine. Contrast dye is injected through the catheter while X-rays of the carotid arteries are taken. This test may be performed to evaluate or confirm the presence of narrowing or blockage in the carotid arteries, determine the risk for future stroke and evaluate the need for future treatment, such as carotid stenting or surgery.
• Magnetic resonance angiogram (MRA): MRA is a type of magnetic resonance image (MRI) scan that uses a magnetic field and radio waves to provide pictures of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from an X-ray, ultrasound, or computed tomography (CT) scan. This test can provide important information about the carotid and vertebral arteries and the degree of stenosis.
• Computerized tomography (CT Scan): A CT of the brain may be performed if a stroke or TIA is suspected to have already occurred. During a CT scan, X-rays pass through the body and are picked up by detectors in the scanner, which produce three-dimensional (3D) images on a computer screen. Depending on the type of scan you need, a contrast material might be injected intravenously (into a vein) so the radiologist can see the body structures on the CT image. This test may reveal areas of damage in the brain.
• Computed tomography angiogram(CTA): A test that uses advanced CT technology, along with intravenous (IV) contrast material (dye), to obtain high-resolution, 3D pictures of the carotid arteries. CTA images enable physicians to determine the degree of stenosis in the carotid and vertebral arteries and can also assess leading to these arteries as well as the blood vessels in the brain.

Management and Treatment

How is carotid artery disease treated?

Carotid artery disease is treated by:

• Making lifestyle changes
• Taking prescribed medications
• Having procedures as recommended

Lifestyle changes

To prevent carotid artery disease from progressing, these lifestyle changes are recommended by your doctor and the National Stroke Association:

• 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:

Medications

Anti-platelet medications:All patients with carotid artery disease should take an anti-platelet medication to reduce the risk of stroke and other cardiovascular disease complications. The most commonly used anti-platelet medication is aspirin.

Other drugs that work to keep platelets from 'sticking together' include clopidogrel (Plavix) and dipyridamole (Persantine), which may be prescribed alone or in combination with aspirin to reduce your risk of stroke. In some cases, the anticoagulant medication warfarin (Coumadin) may be prescribed to thin your blood and reduce the risk of blood clots.

Carotid Pulse Site Definition

Tissue plasminogen activator (t-PA): A clot-dissolving medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of strokes caused by blood clots (ischemic strokes). Eighty percent of all strokes are ischemic. T-PA only works if it is given within three hours of the start of stroke symptoms.

Treatment procedures

Carotid Stenting

If there is severe narrowing or blockage in the carotid artery, a procedure may be necessary to open the artery and increase blood flow to the brain, to prevent a future stroke.

If you have symptoms related to carotid artery narrowing, you will likely need to have either carotid endarterectomy or carotid stenting to correct the narrowing in the artery and reduce your risk of stroke. Your vascular specialist will evaluate you to recommend the best treatment for your situation.

If you have carotid narrowing without symptoms, your vascular specialist will evaluate your test results and risk status to make a recommendation as to whether medical therapy, carotid stenting or carotid endarterectomy would be the best option.

Carotid endarterectomy is the traditional surgical treatment for carotid artery disease. Carotid endarterectomy has been proven to be beneficial for symptomatic patients with a 50 percent or greater carotid stenosis (blockage) and for asymptomatic patients with a 60 percent or greater carotid stenosis.

Carotid endarterectomy can be performed under general anesthesia (the patient is asleep) or local anesthesia with intravenous sedation. During the procedure, an incision is made in the neck at the site of the carotid artery blockage. The surgeon removes the plaque from the artery and when the plaque removal is complete, the surgeon stitches the vessel closed. Blood flow to the brain is restored through its normal path.

Carotid angioplasty and stenting has been FDA-approved as a treatment option for some patients with carotid artery disease. Please talk to your doctor to determine if you are eligible.

The carotid angioplasty and stenting procedure is performed while the patient is awake, but sedated. During the procedure, a balloon catheter is inserted through a sheath in a blood vessel. With X-ray guidance, the catheter is placed through the blood vessel and directed to the carotid artery at the site of the blockage or narrowing. A specially designed guidewire with a filter is placed beyond the area of blockage or narrowing.

Once in place, the balloon tip is inflated for a few seconds to open or widen the artery. The filter (called the embolic protection device) collects any debris that may break off of the blockage. A stent (a small mesh tube) is placed in the artery and opens to fit the size of the artery. The stent stays in place permanently and acts as a scaffold to support the artery walls and keep the artery open. After several weeks, the artery heals around the stent.

Research has shown that carotid stenting, when used with the embolic protection device, was as safe and effective as carotid endarterectomy in high-risk surgical patients.Recovery from both the carotid endarterectomy and carotid angioplasty and stenting procedures generally requires a one-night hospital stay. Patients often return to regular activities within one to two weeks after these procedures.

Follow-up care

Your doctor will want to see you on a regular basis for a physical exam and possibly to perform diagnostic tests. Your doctor will use the information gained from these visits to monitor the progress of your treatment. Check with your doctor to find out when to schedule your next appointment.

Prevention

What are the risk factors for carotid artery disease?

The risk factors that have been linked to the development of atherosclerosis include:

• Family history of atherosclerosis (either carotid artery disease or coronary artery disease or elsewhere in the vascular system)
• Age: In general, the risk of atherosclerosis increases as we age, and in particular, men under age 75 have a greater risk of developing carotid artery disease than women, but after age 75, women have a greater risk than men
• High levels of low density lipoprotein (LDL, bad cholesterol) and triglycerides in the blood. However, this link is not as strong as it is for coronary artery disease
• Sedentary lifestyle

Typically, the carotid arteries become diseased a few years later than the coronary arteries. People who have coronary artery disease, and atherosclerosis elsewhere (such as peripheral artery disease or PAD) have a higher risk of developing carotid artery disease.

Resources

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet. The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

See About Us to learn more about the Sydell and Arnold Miller Heart, Vascular & Thoracic Institute.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Resource Links

• Visit Health Essentials - Read articles on vascular disorders and healthy living on Health Essentials
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In anatomy, the left and right common carotid arteries (carotids) (English: /kəˈrɒtɪd/^[1][2]) are arteries that supply the head and neck with oxygenated blood; they divide in the neck to form the external and internal carotid arteries.^[3][4]

Structure[edit]

The common carotid arteries are present on the left and right sides of the body. These arteries originate from different arteries but follow symmetrical courses. The right common carotid originates in the neck from the brachiocephalic trunk; the left from the aortic arch in the thorax. These split into the external and internal carotid arteries at the upper border of the thyroid cartilage, at around the level of the fourth cervical vertebra.

The left common carotid artery can be thought of as having two parts: a thoracic (chest) part and a cervical (neck) part. The right common carotid originates in or close to the neck and contains only a small thoracic portion. There are studies in the bioengineering literature that have looked into characterizing the geometric structure of the common carotid artery from both qualitative and mathematical (quantitative) standpoints.^[4]

The average diameters of the common carotids in adult males and females are 6.5 mm and 6.1 mm respectively.^[5]

In the chest[edit]

Only the left common carotid artery has a substantial presence in the thorax. It originates directly from the aortic arch, and travels upward through the superior mediastinum to the level of the left sternoclavicular joint.

During the thoracic part of its course, the left common carotid artery is related to the following structures:In front, it is separated from the manubrium of the sternum by the sternohyoid and sternothyroid muscles, the anterior portions of the left pleura and lung, the left brachiocephalic vein, and the remains of the thymus; behind, it lies on the trachea, esophagus, left recurrent laryngeal nerve, and thoracic duct.

To its right side below is the brachiocephalic trunk, and above, the trachea, the inferior thyroid veins, and the remains of the thymus; to its left side are the left vagus and phrenic nerves, left pleura, and lung. The left subclavian artery is posterior and slightly lateral to it.

In the neck[edit]

The cervical portions of the common carotids resemble each other so closely that one description will apply to both.

Each vessel passes obliquely upward, from behind the sternoclavicular joint to the level of the upper border of the thyroid cartilage, where it divides.

At the lower neck the two common carotid arteries are separated from each other by a very narrow interval which contains the trachea; but at the upper part, the thyroid gland, the larynx and pharynx separate the two arteries.

The common carotid artery is contained in a sheath known as the carotid sheath, which is derived from the deep cervical fascia and encloses also the internal jugular vein and vagus nerve, the vein lying lateral to the artery, and the nerve between the artery and vein, on a plane posterior to both. On opening the sheath, each of these three structures is seen to have a separate fibrous cover.

At approximately the level of the fourth cervical vertebra, the common carotid artery splits ('bifurcates' in literature) into an internal carotid artery (ICA) and an external carotid artery (ECA). While both branches travel upward, the internal carotid takes a deeper (more internal) path, eventually travelling up into the skull to supply the brain. The external carotid artery travels more closely to the surface, and sends off numerous branches that supply the neck and face.

At the lower part of the neck the common carotid artery is very deeply seated, being covered by the integument, superficial fascia, the platysma muscle, deep cervical fascia, the sternocleidomastoid muscle, the sternohyoid, sternothyroid, and the omohyoid; in the upper part of its course it is more superficial, being covered merely by the integument, the superficial fascia, the platysma, deep cervical fascia, and medial margin of the sternocleidomastoid.

When the sternocleidomastoid muscle is drawn backward, the artery is seen to be contained in a triangular space known as the carotid triangle. This space is bounded behind by the sternocleidomastoid, above by the stylohyoid and the posterior belly of the digastric muscle, and below by the superior belly of the omohyoid.

This part of the artery is crossed obliquely, from its medial to its lateral side, by the sternocleidomastoid branch of the superior thyroid artery; it is also crossed by the superior and middle thyroid veins (which end in the internal jugular vein); descending in front of its sheath is the descending branch of the hypoglossal nerve, this filament being joined by one or two branches from the cervical nerves, which cross the vessel obliquely.

Sometimes the descending branch of the hypoglossal nerve is contained within the sheath.

The superior thyroid vein crosses the artery near its termination, and the middle thyroid vein a little below the level of the cricoid cartilage; the anterior jugular vein crosses the artery just above the clavicle, but is separated from it by the sternohyoid and sternothyroid.

Behind, the artery is separated from the transverse processes of the cervical vertebrae by the longus colli and longus capitis muscles, the sympathetic trunk being interposed between it and the muscles. The inferior thyroid artery crosses behind the lower part of the vessel.

Medially, it is in relation with the esophagus, trachea, and thyroid gland (which overlaps it), the inferior thyroid artery and recurrent laryngeal nerve being interposed; higher up, with the larynx and pharynx. Lateral to the artery, inside the carotid sheath with the common carotid, are the internal jugular vein and vagus nerve.

When Is The Carotid Pulse Site Used

At the lower part of the neck, on the right side of the body, the right recurrent laryngeal nerve crosses obliquely behind the artery; the right internal jugular vein diverges from the artery. On the left side, however, the left internal jugular vein approaches and often overlaps the lower part of the artery.

Behind the angle of bifurcation of the common carotid artery is a reddish-brown oval body known as the carotid body. It is similar in structure to the coccygeal body which is situated on the median sacral artery.

The relations of the cervical region of the common carotid artery may be discussed in two points:

• Internal relations of organs present inside the carotid sheath
• two external relations of carotid sheath

Collateral circulation[edit]

The chief communications outside the skull take place between the superior and inferior thyroid arteries, and the deep cervical artery and the descending branch of the occipital artery; the vertebral artery takes the place of the internal carotid artery within the cranium.

Variation[edit]

Origin[edit]

The right common carotid may rise above the level of the upper border of the sternoclavicular joint; this variation occurs in about 12 percent of cases.

In other cases, the artery on the right side may arise as a separate branch from the arch of the aorta, or in conjunction with the left carotid.

The left common carotid varies in its origin more than the right.

In the majority of abnormal cases it arises with the brachiocephalic trunk; if that artery is absent, the two carotids arise usually by a single trunk.

It is rarely joined with the left subclavian artery, except in cases of transposition of the aortic arch.

Point of division[edit]

In the majority of abnormal cases, the bifurcation occurs higher than usual, the artery dividing opposite or even above the hyoid bone; more rarely, it occurs below, opposite the middle of the larynx, or the lower border of the cricoid cartilage. In at least one reported case, the artery was only 4 cm in length and divided at the root of the neck.

Very rarely, the common carotid artery ascends in the neck without any subdivision, either the external or the internal carotid being absent; and in a few cases the common carotid has itself been found to be absent, the external and internal carotids arising directly from the arch of the aorta.

Carotid Pulse Site Meaning

This peculiarity existed on both sides in some instances, on one side in others.

Occasional branches[edit]

The common carotid usually gives off no branch previous to its bifurcation, but it occasionally gives origin to the superior thyroid artery or its laryngeal branch, the ascending pharyngeal artery, the inferior thyroid artery, or, more rarely, the vertebral artery.

Clinical significance[edit]

The common carotid artery is often used in measuring the pulse,^[3] especially in patients who are in shock and who lack a detectable pulse in the more peripheral arteries of the body. The pulse is taken by palpating the artery just deep to the anterior border of the sternocleidomastoid muscle at the level of the superior border of the thyroid cartilage.

Presence of a carotid pulse has been estimated to indicate a systolic blood pressure of more than 40 mmHg, as given by the 50% percentile.^[6]

Carotidynia is a syndrome marked by soreness of the carotid artery near the bifurcation.

Carotid stenosis may occur in patients with atherosclerosis.

The intima-media thickness of the carotid artery wall is a marker of subclinical atherosclerosis, it increases with age and with long-term exposure to particulateair pollution.^[7]

Gallery[edit]

• Magnetic Resonance Angiography

• Normal carotidal arteriography

• Common carotid artery

• Common carotid artery – right view

• Brachial plexus and common carotid artery

• Common carotid artery

• Common carotid artery

• Right and left common carotid arteries

See also[edit]

References[edit]

1. ^OED 2nd edition, 1989.
2. ^Entry 'carotid' in Merriam-Webster Online Dictionary.
3. ^ ^abAshrafian H (March 2007). 'Anatomically specific clinical examination of the carotid arterial tree'. Anatomical Science International. 82 (1): 16–23. doi:10.1111/j.1447-073X.2006.00152.x. PMID17370446.
4. ^ ^abManbachi A, Hoi Y, Wasserman BA, Lakatta EG, Steinman DA (December 2011). 'On the shape of the common carotid artery with implications for blood velocity profiles'. Physiological Measurement. 32 (12): 1885–97. doi:10.1088/0967-3334/32/12/001. PMC3494738. PMID22031538.
5. ^J. Krejza; M. Arkuszewski; S. Kasner; J. Weigele; A. Ustymowicz; R. Hurst; B. Cucchiara; S. Messe (April 2006). 'Carotid Artery Diameter in Men and Women and the Relation to Body and Neck Size'. Stroke. 37 (4): 1103–1105. doi:10.1161/01.STR.0000206440.48756.f7. PMID16497983.
6. ^Deakin CD, Low JL (September 2000). 'Accuracy of the advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral, and radial pulses: observational study'. BMJ. 321 (7262): 673–4. doi:10.1136/bmj.321.7262.673. PMC27481. PMID10987771.
7. ^Provost, E; Madhloum, N; Int Panis, L; De Boever, P; Nawrot, T (2015). 'Carotid Intima-Media Thickness, a Marker of Subclinical Atherosclerosis, and Particulate Air Pollution Exposure: the Meta-Analytical Evidence'. PLOS ONE. 10 (5): e0127014. doi:10.1371/journal.pone.0127014. PMC4430520. PMID25970426.

External links[edit]

• Anatomy figure: 21:06-01 at Human Anatomy Online, SUNY Downstate Medical Center