Carotid Artery Disease

What Is Carotid Artery Disease?

Carotid artery disease, or carotid artery stenosis, occurs when a fatty substance (plaque) builds up in the blood vessels carrying blood to your brain (carotid arteries). This plaque buildup is called atherosclerosis.

Plaque buildup causes narrowing (stenosis) in your carotid arteries and can disrupt normal blood flow. Atherosclerosis in your carotid arteries increases your risk of stroke. A stroke is a medical emergency that occurs because of a sudden disruption of blood flow to your brain.

Many people with carotid artery disease worry about having a stroke. But it’s important to understand that stroke risk is very low for many patients with carotid artery disease. Your stroke risk depends on how blocked your arteries are and whether you have had any stroke symptoms before.

Carotid Artery Disease Symptoms

Many people don’t have any symptoms of carotid artery disease. Some people find out they have carotid artery disease after a stroke or transient ischemic attack (TIA or temporary stroke).

A stroke can occur when a piece of plaque from your carotid artery or a group of platelets (blood cells) breaks away and travels to your brain, cutting off blood supply. A TIA occurs for the same reason, but the blood flow blockage is temporary.

A stroke or TIA both cause sudden, emergency symptoms, including:

Difficulty communicating or slurred speech
Facial drooping on one side
Loss of sensation on one side of your body
Muscle weakness on one side of your body
Temporary blindness, especially in one eye

If you notice any stroke or TIA symptoms in yourself or someone else, call 911 immediately. The sooner you get treatment, the better the chances for a good outcome.

Carotid Artery Disease Causes and Risk Factors

Carotid artery disease develops because of atherosclerosis. Several factors can increase your chances of plaque buildup in your arteries:

Diabetes
Family history of atherosclerosis
High blood pressure (hypertension)
High cholesterol
Lack of exercise
Smoking

Diagnosing Carotid Artery Disease

Often, people find out they have carotid artery disease when they get imaging of their neck for a different reason. In some cases, your doctor might hear a “whooshing” sound (carotid bruit) when they listen to your neck’s blood vessels with a stethoscope.

Your vascular surgeon usually diagnoses carotid artery disease with a duplex ultrasound. This test uses sound waves to measure blood flow through your arteries and check for blockages.

During diagnosis, your surgeon evaluates how severely your carotid artery is blocked. They categorize the condition as:

Mild: Less than 50% blocked
Moderate: 50% to 79% blocked
Severe: 80% or more blocked

Sometimes, your vascular surgeon uses computed tomography (CT) or magnetic resonance (MR) angiography. These tests involve injecting a special dye into your blood vessels and then using imaging to view any blockages. Your surgeon usually uses angiography only when you have severe carotid artery disease and may need a procedure to treat it.

Carotid Artery Disease Treatment

The goal of carotid artery disease treatment is to slow plaque buildup and lower your risk of stroke. Your treatment plan depends on how blocked your arteries are and whether you’ve had prior stroke symptoms.

Many people successfully manage carotid artery disease with noninvasive treatments. Your vascular surgeon typically recommends surgery when your artery is 80% or more blocked. The surgical approach they use depends on the severity of the blockage and its location in the artery.

Lifestyle changes

You may slow plaque buildup and manage stroke risk with healthy lifestyle changes, such as:

Eating a nutritious diet
Exercising more
Quitting smoking

Medications

Your doctor may prescribe medicines that:

Control your blood pressure
Lower your cholesterol
Prevent blood clots

Carotid endarterectomy

Carotid endarterectomy is the traditional surgery to treat carotid artery disease. During an endarterectomy, your vascular surgeon:

Makes an incision over your carotid artery
Clamps your artery to control bleeding and prevent plaque from breaking off and going to your brain during surgery. Sometimes, your surgeon places a shunt (thin, flexible tube) into your artery instead of clamping it. The shunt keeps blood flowing to your brain but directs it away from the surgery site.
Opens the artery and removes the plaque
Removes the shunt (if one was used) and closes the artery and incision

Your surgeon may use electroencephalogram (EEG) mapping throughout the operation to monitor your brain function. The EEG helps your surgeon decide if they need to use a shunt. EEG mapping involves placing small discs (electrodes) on your scalp that measure your brain’s electrical activity.

You stay overnight in the hospital to monitor your blood pressure and watch for complications. You’ll have to avoid driving for a few days and may have some minor pain. Most people resume their usual activities in about a week.

Carotid stenting with transcarotid artery revascularization (TCAR)

Vascular surgeons also perform carotid stenting with TCAR. This technique is often a good alternative to endarterectomy for people who have a high risk of complications from open surgery. However, it may not be appropriate for people who have very hardened plaque or blockages very low in the carotid artery.

In this minimally invasive procedure, your surgeon uses a thin, flexible tube (catheter) to insert a small spring-like device (stent) that keeps your artery open.

During carotid stenting, your vascular surgeon:

Makes a small incision just above your collarbone to access your carotid artery
Inserts a tube (sheath) into your artery and a catheter through a blood vessel in your groin. The sheath attaches to a filtration system that reverses blood flow away from your brain and catches any plaque pieces that break away. The filtered blood returns to your body through the catheter in your groin.
Places a stent into your carotid artery to push plaque out of the way and keep the artery open
Removes the sheath and catheter to restore the direction of blood flow
Closes the incision

You stay in the hospital overnight and usually resume your typical activities within a week

Monitoring Carotid Artery Disease

All patients with carotid artery disease get yearly ultrasounds with a vascular surgeon. This test checks whether the blockage is worsening. If it is, you may need treatment.

Providers

Our vascular surgeons collaborate with multiple specialists, including radiologists, cardiologists, neurologists and primary care providers, to offer comprehensive carotid artery disease treatment. You get leading-edge care from physician-scientists dedicated to advancing the field through research and innovation.

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