Carotid Artery Stenosis

Carotid stenosis is a condition that occurs when your carotid arteries, the large arteries on each side of your neck, become narrowed. The narrowing is caused by a substance called plaque (fatty cholesterol deposits). When it blocks the normal blood flow in your carotid arteries, you are at risk for stroke. The buildup of plaque is called atherosclerosis.

You have two carotid arteries, one on each side of your neck. These are large arteries that bring blood to your brain, face, and head. When healthy, these arteries are smooth and open, like a clear pipe that allows blood to flow freely without any obstruction. Your body’s circulatory system consists of a network of blood vessels that carry blood (which contains nutrients and oxygen) to all parts of your body.

You may develop a narrowing of the carotid artery (carotid artery stenosis) in one or both of the two arteries in your neck. If left untreated, this condition can worsen over time and lead to a stroke, which can cause serious complications including death.

How common is carotid artery stenosis?

The incidence of carotid artery stenosis in the general population is estimated to be as high as 5%. According to the American Stroke Association, stroke is the fifth leading cause of death. Carotid artery stenosis is a condition that usually occurs in older age groups, and as people age, the incidence of this condition increases, along with the risk of stroke.

What are the causes and risk factors of carotid artery stenosis?

There are several factors that can cause carotid artery stenosis over time. Some of these are factors you can change. Others contribute to other factors and further increase your risk:

Smoking and using tobacco products.
Being obese.
Living a sedentary lifestyle.
Having hypertension.
High cholesterol.
Diabetes.
Older age.

What are the symptoms of carotid artery stenosis?

Carotid artery stenosis can cause a stroke. A stroke caused by carotid artery stenosis occurs when plaque fragments (or platelets that form on the plaque) travel to your brain. This stroke, called an “ischemic” stroke, cuts off blood flow to part of your brain. When this blockage becomes permanent, your brain cells or neurons begin to die.

A transient ischemic attack (TIA) is a “mini-stroke,” meaning a small brain artery is temporarily blocked by plaque and/or platelets. For many people, a TIA precedes an ischemic stroke. In these cases, it is very important to seek treatment as soon as possible to prevent cell death.

What are the symptoms of a stroke?

Symptoms of a TIA or stroke may include:

Dropping of one side of your face.
Slurred speech or difficulty forming words and communicating with others.
Loss of feeling on one side of your body.
Loss of vision in one eye, with a dark shadow over your field of vision.
Losing muscle strength and having weakness on one side of your body.

If you have carotid artery stenosis that doesn’t cause a stroke, you may not notice any symptoms.

How is carotid artery stenosis diagnosed?

Carotid artery stenosis is often diagnosed after you have symptoms of a stroke. The symptoms prompt your doctor to thoroughly investigate any blockages, which may lead to the diagnosis of carotid artery stenosis. This condition can also be diagnosed when your doctor hears an abnormal sound called a whistling or bruit while examining your neck with a stethoscope. There are several tests that can be used to confirm a diagnosis of carotid artery stenosis and to learn more about the extent and location of the blockage. These tests may include:

Ultrasound: Also called a Doppler ultrasound, this type of test uses sound waves to create an image of the inside of your body. An ultrasound is a painless test done on your skin. Ultrasound is used to see how blood flows through your arteries and to find areas where they may be blocked or narrowed.
Computed tomography angiography (CTA): A detailed image of your carotid arteries can be obtained using a CT scanner, a device that uses X-rays to create detailed images of your internal organs. During this test, a drug called “contrast medium” is injected into your bloodstream to help show blockages in the images. This test may be used in people who have a pacemaker or stent for other conditions.
Cerebral angiography: This type of diagnostic test involves using a catheter in a minimally invasive procedure to go into your arteries and closely examine the blockage. In this test, your doctor injects contrast medium directly into your arteries so they can see details of your arteries.
Magnetic resonance angiography (MRA): This test provides detailed images of your arteries, similar to a CT scan but without the use of X-rays. It’s a noninvasive imaging test.

How is carotid artery stenosis classified?

During the diagnosis process, your doctor will look at whether you have this condition, to what extent, and where it is. Carotid artery stenosis is generally divided into three groups: mild, moderate, and severe. A mild blockage is less than 50%. This means that less than half of your artery is blocked. A moderate blockage is between 50% and 79%. The most severe classification includes the group where the majority of your artery (80% to 99%) is narrowed.

How is carotid artery stenosis treated?

The main goal of carotid artery stenosis treatment is to stop the progression of the disease. This starts with lifestyle changes that include healthy eating, exercise, and quitting smoking. Daily baby doses of aspirin can be used along with medications that lower blood pressure and cholesterol.

In more severe cases and/or cases that cause TIA or stroke symptoms, your doctor may perform a surgical procedure called “carotid endarterectomy” to remove plaque from the carotid artery through an incision.

Carotid endarterectomy surgery is a surgical method that we perform quite a lot. We prefer to perform this surgery under local anesthesia, by talking to the patient. The purpose of performing it under local anesthesia is to minimize the risk of stroke due to the surgery. This method is currently considered the gold standard in preventing the risk of stroke in carotid endarterectomy, and you can access our scientific article on the subject here.

As an alternative to carotid endarterectomy surgery in the treatment of carotid artery stenosis, a radiologist experienced in this field can also place a stent in your narrowed artery. This will open the artery to its proper size while removing plaque from the blood flow between the stent and the wall. A “stroke team” consisting of a cardiovascular surgeon, neurologist, and radiologist determines which of these procedures is best for each person who needs treatment for carotid disease.

Not every narrowing of the carotid artery requires surgery or interventional treatment, because these procedures themselves carry risks. Surgeons recommend intervention only when the risk of severe stenosis and/or stroke outweighs the risk of the procedure.

What is the outcome of carotid endarterectomy or stenting?

Carotid artery stenosis can be dangerous if not caught and treated quickly. It can lead to a stroke, which can be fatal or disabling. It is important to know the signs of a stroke and to act quickly if you recognize these signs in yourself or someone else. Prompt treatment of carotid artery stenosis can be lifesaving. The results of carotid endarterectomy and stenting, when necessary, are excellent. Most people recover very quickly, with only a few nights in hospital.

In summary

As you age, your risk of developing carotid artery stenosis increases. The most important thing you can do to prevent this condition and complications like stroke is to live a healthy lifestyle. Examples of a healthy lifestyle include exercise, eating a healthy diet, and not smoking. Talk to your doctor regularly about ways to keep your heart and entire circulatory system healthy. For more detailed information about carotid artery stenosis, you can contact us here .