Carotid Artery Stenosis

Definition

Carotid artery stenosis is when the carotid arteries, or blood vessels on each side of the neck, narrow. They supply blood from the heart to the brain.

This condition can lead to a stroke and transient ischemic attacks (TIA) or mini strokes.

Blood Supply to the Brain

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Causes

Carotid artery stenosis is caused by the buildup of plaque in the arteries. This buildup is called atherosclerosis. Plaque is made of cholesterol, fat, and other substances.

Less common causes are problems in the carotid artery, such as:

• An injury or tear
• Arteritis (inflammation)
• A blood clot
• A tumor

Risk Factors

Carotid artery stenosis is more common in men and people over 60 years of age. Other things that raise the risk are:

• Diabetes
• High blood pressure
• Smoking
• Problems with blood fat levels, such as:
  • High cholesterol
  • High triglycerides
• Narrowing of other arteries, such as:
  • Coronary artery disease—affects heart vessels
  • Peripheral artery disease (PAD)—affects leg vessels
• Aortic aneurysm—a weak, bulging vessel from the heart

Symptoms

There are usually no symptoms. When symptoms happen, they may be those of a stroke or a transient ischemic attack (TIA or mini-stroke). Symptoms may be:

• Short-term loss of sight in one eye or dim vision
• Weakness, numbness, or tingling of the face, arm, leg, or one side of the body
• Face drooping
• Lightheadedness
• Problems with balance or falling
• Loss of consciousness
• Nausea or vomiting
• Problems with speaking, thinking, understanding, or memory

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done.

Imaging tests can diagnose blood vessel problems. They may include:

• Carotid ultrasonography
• Computer tomography angiography (CTA)
• Magnetic resonance angiography (MRA)

Treatment

The goal of treatment is to improve blood flow to the brain and prevent a stroke. Treatment depends on how severe the condition is. It also depends on if there are symptoms.

Treatment options may be:

• Medicines to:
  • Thin blood
  • Lower cholesterol
  • Manage other health issues a person may have, such as high blood pressure and diabetes
• Lifestyle changes such as:
  • Quitting smoking
  • Eating a healthful diet
  • Getting regular physical activity

Surgery may be needed for severe plaque buildup. Options are:

• Carotid endarterectomy—cleaning the plaque from the artery
• Carotid angioplasty and stenting—inserting a stent to keep the artery open

Prevention

There are no guidelines to prevent carotid artery stenosis. A person may be able to lower their risk of having it by:

• Working out regularly
• Eating more fruits and vegetables and eating less salt and fat
• Not smoking
• Not drinking alcohol, or drinking it in moderation—this means:
  • No more than 2 drinks per day for men
  • No more than 1 drink per day for women
• Keeping other health issues under control such as high cholesterol, high blood pressure, and diabetes