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Carotid Artery Disease (Stenosis)

Carotid artery disease, also known as carotid artery stenosis, is a narrowing of the carotid arteries commonly caused by a build up of plaque (fatty deposits). Over time, the buildup of fatty substances and cholesterol narrows the carotid arteries. This decreases blood flow to the brain and increases the risk of a stroke.

Carotid disease is very highly associated with stroke. Approximately 75% of all ischemic strokes occur in the distribution of the carotid arteries in the neck. Commonly, a piece of the plaque that develops in the carotid artery breaks off and travels to the brain causing either Transient ischemic attack (TIA) or stroke.

Detecting and Diagnosing Carotid Disease

Carotid disease is usually discovered either because a patient experiences symptoms or because a physician listens over the neck and hears an abnormal sound called a bruit during a routine physical examination. It is important to recognize the symptoms that may herald an oncoming stroke so that medical care can be started as soon as possible.

Diagnostic Methods

The most common method of diagnosing carotid artery disease is duplex ultrasound. Duplex ultrasound is a non-invasive method of imaging the arteries to determine whether there is significant plaque.

Occasionally other studies may be needed, such as an MR angiogram, CT angiogram or a traditional contrast angiogram. When performed by trained ultrasound technicians in an accredited diagnostic vascular ultrasound laboratory such as the one at UC San Diego Health, carotid duplex ultrasound is extremely reliable. In most cases, this is the only study needed for planning surgical treatment.

Treatment of Carotid Disease

Carotid artery disease may be treated by medical therapy, surgery or by a combination depending on the individual patient’s situation.

In recommending treatment for a patient, the physician considers these factors:

  • Whether or not you have symptoms
  • How much narrowing (stenosis) is present according to ultrasound or angiogram tests

Carotid Endarterectomy

Studies show that a surgical procedure called carotid endarterectomy is clearly more effective than medical treatment in patients who meet any of the following conditions:

  • The patient is symptomatic and has greater than 70% stenosis
  • The patient has no symptoms and has greater than 80% stenosis based on ultrasound or 60% by angiography
  • The patient has moderate-grade carotid artery stenosis which is continuing to cause symptoms even with medical management

In patients who have symptoms and greater than 70 percent stenosis, the results of a large number of prospective randomized trials show that treatment with a combination of carotid endarterectomy and aspirin results in dramatically lower rates of stroke than treatment with aspirin alone.

For this reason, surgical treatment is recommended for symptomatic patients who have a greater than 70 percent stenosis as well as for symptomatic patients who have greater than 50 percent stenosis and are continuing to have symptoms despite being on medical therapy.

Carotid Artery Stenting

The treatment of carotid artery disease has evolved over the years and continues to evolve. In recent years, another procedure, carotid stenting, has emerged as a treatment option for carotid disease.

Individual patients can help reduce their risk of stroke by controlling hypertension, recognizing the symptoms of carotid artery disease and seeking medical care when symptoms occur.