Carotid Artery Stenosis

Getty Images/ SHUBHANGI GANESHRAO KENE

Carotid artery stenosis is one of the causes of stroke. If you have been told that you have carotid artery stenosis, you may have been told that you need to have an interventional procedure to reduce your risk of stroke, or you may have been told that it is best to watch and wait.

What Are the Carotid Arteries?

Arteries carry oxygen rich blood and nutrients to various parts of the body. The common carotid arteries are two of the most important blood vessels that carry blood to the brain.

There are two common carotid arteries, one on each side of the neck.

The right and left common carotid arteries are large arteries that each branch out into smaller arteries, including the internal carotid artery, the external carotid artery and the middle cerebral artery. Each of these smaller arteries supplies blood to a region of the brain, the head or the face. 

What is Carotid Artery Stenosis?

Stenosis means narrowing. When one of the carotid arteries becomes narrow on the inside, this can compromise blood flow to the brain. Generally, the narrowing is not just a smooth narrowing on the inside of the artery. The narrowing is caused by a buildup of irregular debris inside the carotid artery. In addition to decreasing blood flow, the debris may dislodge and block off a small blood vessel inside the brain, causing an ischemic stroke.

What Causes Carotid Artery Stenosis?

Atherosclerosis is a blood vessel disease characterized by the deposit of fat and debris along the blood vessel walls, leading to a progressive narrowing of the opening through which blood flows.

Atherosclerosis is caused by long term hypertension, heart disease and high cholesterol and fat levels. Some people are also genetically predisposed to atherosclerosis.

Other abnormalities that can cause narrowing and decreased blood flow through the carotid arteries include a thrombus (blood clot), carotid dissection, arteritis, and fibromuscular displasia.

What Are the Signs of Carotid Artery Stenosis?

Most of the time, carotid artery stenosis does not produce any symptoms. Your doctor can often hear the sound of carotid artery stenosis by listening to the blood vessels in your neck with a stethoscope. This test, called carotid auscultation, is one of the routine tests that your doctor checks during your annual physical. Sometimes, carotid stenosis does not produce any abnormal sounds that could be detected by carotid auscultation.

Carotid artery stenosis can cause a reversible mini-stroke, which is a transient ischemic attack (TIA.) A TIA is similar to a stroke, except that it improves completely without causing any lasting damage. Symptoms of TIA include numbness or weakness of the face, arm or leg, trouble speaking or changes in vision. If you have a TIA, that is a sign that you are at risk of stroke. A TIA is the most common sign of carotid artery stenosis.

Is There a Test for Carotid Artery Stenosis?

There are a few imaging tests that can define the location of carotid artery stenosis and can determine the severity of the stenosis.

These diagnostic tests include carotid ultrasound, neck MRA, and neck CTA. You will probably only need to have one of these imaging tests, and the results will play a large role in determining the best treatment plan for your condition.

What Can You Do About Carotid Artery Stenosis?

Physicians take carotid artery stenosis very seriously, especially when you have symptoms of a TIA.

Carotid artery stenosis can be repaired with a surgical procedure called a carotid endarterectomy. The guidelines for carotid stenosis surgery indicate that people who have experienced symptoms and who also have at least 70% narrowing of one the internal carotid arteries should be considered optimal candidates for carotid stenosis surgery. This procedure can significantly reduce the risk of future stroke.

However, a carotid endarterectomy is not necessarily the best solution for everyone who has carotid stenosis. If you would not be able to tolerate surgery due to a health condition, then your doctor might recommend carefully following the region of stenosis or might recommend a different procedure to repair the area of stenosis. There are other procedures besides carotid endarterecomy that may be more suitable for some people, and one of these procedures might be best for you.

Edited by Heidi Moawad MD

Sources:

Immediate versus delayed treatment for recently symptomatic carotid artery stenosis.Vasconcelos V, Cassola N, da Silva EM, Baptista-Silva JC, Cochrane Database Syst Rev. 2016 Sep 9;9:CD011401.

Continue Reading