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Carotid Stenosis/Disease

Carotid disease involves the build-up of plaque, a substance made of fats, cholesterol, and other substances, in the carotid arteries, the main blood vessels that supply oxygen and nutrients to the brain. This buildup, known as atherosclerosis, can lead to narrowing or blockage (stenosis) of the arteries, which can significantly reduce blood flow to the brain.

Symptoms of Carotid Disease

While carotid stenosis can often be asymptomatic (show no symptoms), it can sometimes lead to stroke-like symptoms, including:

  • Sudden weakness or numbness of the face, arms, or legs, often on one side of the body.
  • Sudden confusion, trouble speaking or understanding speech.
  • Sudden trouble seeing in one or both eyes.
  • Sudden trouble walking, dizziness, or loss of balance or coordination.
  • Sudden severe headache with no known cause.

These symptoms can occur when the blood flow to part of the brain is cut off, resulting in a stroke. However, they may also be transient (temporary) and resolve within 24 hours. This is known as a transient ischemic attack (TIA), or a ‘mini-stroke’.

Indications for Treatment

Treatment may be recommended for carotid stenosis in the following circumstances:

  • Symptomatic carotid stenosis: If you’ve had a stroke or TIA and your doctor discovers that you have significant carotid stenosis (usually greater than 50% blockage), treatment may be recommended to reduce the risk of another stroke.
  • Asymptomatic carotid stenosis: If you have not had any symptoms but your doctor finds significant carotid stenosis (usually greater than 60-70% blockage), you may be considered for treatment to prevent a stroke from occurring in the future.

Treatment Options

There are two main surgical treatments for carotid stenosis: carotid endarterectomy (CEA) and carotid artery stenting (CAS).

  1. Carotid Endarterectomy (CEA): This is a surgical procedure that involves making an incision in the neck to access the affected carotid artery. The surgeon opens the artery and removes the plaque that is causing the blockage. The artery is then repaired.
  2. Carotid Artery Stenting (CAS): This is a less invasive procedure that involves inserting a small, flexible tube (catheter) through a large artery (usually in the groin) and threading it up to the affected carotid artery. A small balloon at the end of the catheter is inflated to widen the artery, and a small metal coil (stent) is placed in the artery to keep it open.

Both CEA and CAS have been shown to be effective in reducing the risk of stroke, but each has its own risks and benefits, which can depend on individual patient factors such as age, overall health, and the specific characteristics of the stenosis. Your doctor will discuss these options with you and help you make the best decision for your situation.

Additional Resources

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