Carotid Artery Disease

The carotid arteries are the main arteries in your neck that supply blood to your brain. A substance called plaque accumulates inside your arteries as you age. If too much plaque builds up in your carotid arteries, it can cause them to narrow (carotid stenosis). Small clots can form, then break off and travel to the brain, causing a minor or major stroke. Up to 3% of individuals older than 65 have carotid artery disease. Your risk increases as you age, and is heightened if you have a history of smoking, high blood pressure, high cholesterol, diabetes or heart disease. Carotid stenosis is responsible for up to one-third of all strokes. About 700,000 strokes occur every year and cause 1 in every 15 deaths.


The first sign of carotid artery disease may be a stroke, mini-stroke or TIA symptoms, such as weakness or numbness on one side of your body, slurred speech or facial drooping. Most people with carotid artery disease, even with severe blockage, experience no symptoms. The condition is often found in a routine physical exam. A whistling sound or “bruit” coming from the carotid artery, heard with a stethoscope, may indicate plaque is building up inside the artery and lead your doctor to recommend you see a vascular surgeon.


The most common cause, a build-up of plaque in the carotid arteries, can occur due to multiple risk factors, such as smoking, high cholesterol, high blood pressure and diabetes. In rare cases, the carotid arteries may narrow due to inflammation.


If carotid artery disease is suspected your doctor will perform a carotid artery duplex ultrasound scan. This noninvasive test can determine whether there is a narrowing in the arteries and if so, provide an accurate estimate of severity. In certain cases, alternative radiological tests are sometimes used to determine the presence and degree of any narrowing. These include a computerized tomography (CT) scan, magnetic resonance angiography (MRA) or angiogram.


Treatment for carotid artery disease is given to reduce the possibility of stroke or recurrence of stroke. Specifics depend on the degree of artery narrowing: When the degree of narrowing is less than 50-60%, aspirin and medications that lower your cholesterol and blood pressure are commonly prescribed. Lifestyle changes such as a healthy diet, exercise and quitting smoking are also helpful.

If the degree of narrowing is greater than 60%, you may benefit from a carotid endarterectomy or carotid angioplasty and stenting. Your doctor can advise you on which of the procedures is best for your condition.