Carotid Artery Disease

A carotid artery on each side of the neck supplies blood to the brain. Carotid artery disease occurs when a substance called plaque builds up in either or both arteries. The buildup may narrow the artery and limit blood flow to the brain. If this plaque breaks open, it may form a blood clot. Or pieces of the plaque may break off. A piece of plaque or a blood clot could move to the brain and cause a stroke or transient ischemic attack (TIA).

The narrowing in an artery is called stenosis. The more narrow an artery becomes, the greater the risk of stroke or TIA.

Carotid artery disease is caused by a process called hardening of the arteries, or atherosclerosis. Plaque builds up inside the carotid arteries. Things that can lead to this buildup include:

• Smoking.
• High blood pressure.
• High cholesterol.
• Diabetes.
• A family history of hardening of the arteries.

Many people have no symptoms. In some people, a doctor can hear a sound in their neck called a bruit (pronounced "broo-EE"). This is a whooshing sound that happens when a carotid artery is narrowed.

For some people, a transient ischemic attack (TIA) or stroke is the first sign of the disease.

If you have any of these symptoms of a TIA or stroke, call 911 or other emergency services right away.

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

An ultrasound test is used to diagnose carotid artery disease. This test uses sound waves to show how blood flows through your carotid arteries. You may have other tests such as a CT angiogram or a magnetic resonance angiogram (MRA) to check your carotid arteries.

Screening tests for carotid artery disease are not recommended for people who do not have signs or symptoms of carotid artery disease [1], [2] If you have risk factors, signs, or symptoms of carotid artery disease, your doctor may recommend an ultrasound test to check for it [2], [3].

Some companies sell ultrasound screening. But insurance doesn’t pay for these tests because experts don’t recommend them. And since your doctor didn’t prescribe the tests, they aren’t there to explain the results to you. It’s a good idea to talk to your doctor before having one of these tests.

The goal of treatment is to lower your risk of a stroke. Treatment depends on whether you have symptoms and how narrow your arteries are. You probably will take medicine. You also will be encouraged to have a heart-healthy lifestyle. Some people also have a procedure to lower their risk.

You may take aspirin or another medicine to prevent blood clots. You will likely also take medicine to lower cholesterol. You may also take medicine to help manage blood pressure.

A heart-healthy lifestyle can help lower your risk of stroke.

• Don’t smoke. Avoid secondhand smoke too.
• Eat heart-healthy foods.
• Be active. Ask your doctor what type of exercise is safe for you.
• Stay at a healthy weight. Lose weight if you need to.
• Manage other health problems, such as diabetes. If you think you may have a problem with alcohol or drug use, talk to your doctor.
• Get vaccinated against COVID-19, the flu, and pneumonia.

Your doctor may recommend regular ultrasounds. This is to see if the narrowing in your arteries is getting worse.

Surgery in the arteries is called carotid endarterectomy. The doctor makes a cut in the neck and takes the plaque out of the artery.

Some people have a stent placed inside a carotid artery. A stent may be inserted during a catheter procedure. In this procedure, a doctor puts a thin tube, called a catheter, into a blood vessel in your groin or arm. The doctor threads the tube up to the carotid artery in the neck. The catheter is used to place the stent. In another type of procedure, a stent is placed in the artery through a cut in the neck.

Surgery and stenting may help lower your risk of a stroke. But they also have a risk of serious problems. You and your doctor can decide together if you want to have surgery or stenting.