What Is the Best Treatment for Carotid Artery Stenosis?

Carotid artery stenosis or carotid artery disease is a slowly developing condition that occurs due to the accumulation of fatty cholesterol deposits (plaques) and clogs the blood vessels that deliver blood to the brain and head (carotid arteries).

This blockage increases the risk of stroke, a medical emergency that occurs when the blood supply to the brain is interrupted, depriving it of oxygen.

According to the American Stroke Association, stroke is the fifth most common cause of death and the leading cause of permanent disability in the United States.

The first sign of carotid artery stenosis is often a stroke or a transient ischemic attack (TIA). A TIA is a temporary shortage of blood flow to the brain.

Depending on the extent of blockage, carotid artery stenosis is classified into three groupings:

1. Mild: Less than 50 percent blockage
2. Moderate: 50 to 79 percent blockage
3. Severe: 80 to 99 percent blockage

Carotid artery disease is caused by the accumulation of plaques in either of the two carotid arteries (located on each side of the neck), which blocks the normal flow of blood to the brain, face, and head. This process of building and blocking the arteries is called atherosclerosis.

Plaques are made up of clumps of cholesterol, calcium, fibrous tissue, and other cellular debris accumulating at the microscopic injury sites within the affected artery. 

Carotid arteries that are clogged with plaques are hard and narrow, leading to trouble delivering oxygen and nutrients to vital brain structures responsible for day-to-day functioning.

Factors that may increase the vulnerability of carotid artery disease include:

• Hypertension (high blood pressure)
• Smoking and tobacco use
• Diabetes
• High blood-fat levels (low-density lipoprotein cholesterol and triglycerides)
• Family history of carotid artery disease 
• Advancing age
• Obesity
• Sedentary lifestyle
• Sleep apnea
• Lack of exercise

In its early stages, carotid artery disease may not cause any symptoms or only milder symptoms. The condition may go unnoticed until the brain is seriously deprived of blood, causing a stroke or transient ischemic attack (TIA).

A person with a stroke or TIA may experience symptoms such as:

• Sudden numbness or weakness (decreased muscle strength) in the face or limbs (often on one side of the body)
• Trouble speaking/slurred speech
• Trouble understanding (confusion) and communicating with others
• Loss of coordination or movement
• Temporary loss of vision in one or both eyes
• Sudden dizziness or loss of balance
• Severe headache (with no apparent cause)

Apart from a thorough medical history and physical examination, which involves listening for a swooshing or whistling sound (bruit) over the carotid artery in the neck (a sound that's characteristic of a narrowed artery), the doctor may recommend the following tests:

• Ultrasound: To assess blood flow and pressure in the carotid arteries using sound waves
• CT scan or MRI scan: To analyze the evidence of stroke or other abnormalities
• Computed tomography angiography or magnetic resonance angiography: To provide additional images of blood flow in the carotid arteries using an injectable dye to help show any blockages on the images.