Carotid Artery Stenosis

What is carotid artery stenosis?

Carotid artery stenosis occurs when the arteries on the side of the neck become narrow due to a build-up of plaque or fatty material. This plaque inside the arteries, or atherosclerosis, restricts the full blood flow to the head, face, and brain from the arteries, which puts someone at greater risk of a completely blocked artery. Carotid artery stenosis, or stenosis for short, can worsen over time and eventually cause a stroke.

Carotid artery disease can lead to a stroke in two different ways. The first is by restricting the blood flow of the arteries. The second is when a piece of the plaque or fatty material loosens and travels to the brain.

What are the symptoms of carotid artery blockage?

Carotid artery blockage symptoms are not typically felt until a stroke occurs. Some people may experience symptoms before a stroke, including dizziness, fainting, and blurred vision. These symptoms indicate restricted blood flow to the brain.

A stroke or transient ischemic attack (TIA) is another symptom of stenosis. This typically occurs when a piece of the plaque or a blood clot that has formed in the arteries travels to the brain. This can cause an ischemic stroke, which cuts the blood supply to the brain and causes brain cells to die.

A TIA—often called a mini-stroke—occurs when the carotid artery blockage is only temporary. Although it does not result in the death of brain cells, it is often a warning sign of a stroke.

Stroke symptoms include drooping on one side of the face, slurred speech, diminished vision, a sudden or severe headache, and sudden dizziness.

Request an appointment with the heart specialists at Mass General Brigham to learn more about diagnosis and treatment options for carotid artery stenosis.

How are blocked carotid arteries classified?

A doctor will use tests to determine how much blockage is in the carotid arteries. Based on this information, carotid artery stenosis is classified in one of three categories:

• Mild: The carotid artery has less than 50% blockage
• Moderate: The carotid artery has a blockage of 50% to 79%
• Severe: An almost fully blocked carotid artery, between 80% to 99%

What causes stenosis of the carotid artery?

Carotid artery stenosis is caused by a fatty material or plaque buildup in the arteries located in the neck. The medical term for this type of buildup is atherosclerosis, which is deposited on the inner walls of the arteries.

Risk factors for carotid artery stenosis

Numerous risk factors contribute to carotid artery stenosis, including family history, age, obesity, smoking and tobacco use, and a sedentary lifestyle.

Other risk factors include:

• High blood pressure
• Diabetes
• High cholesterol or elevated lipids

How is carotid artery stenosis diagnosed?

A healthcare provider will check for signs of carotid artery stenosis if a patient has exhibited signs of a possible stroke. The first step is for the doctor to listen to the neck through a stethoscope for abnormal sounds, such as a whistling or murmur. Different tests can confirm the presence of a blockage. The doctor may order an ultrasound of the carotid artery or a computed tomography angiography (CTA), which produces an image of the carotid arteries.

Other diagnostic tests include cerebral angiography, which involves a catheter being placed in the arteries while injecting a material into them so the doctor can trace the blockage. Magnetic resonance angiography (MRA) is another noninvasive option for looking inside the arteries.

What is carotid artery stenosis treatment?

Carotid artery blockage treatment often requires a multi-step approach. A combination of medications, surgical procedures, and lifestyle changes may all be part of carotid artery treatment without surgery.

Lifestyle changes such as losing weight, quitting smoking, reducing salt intake, regular exercise, and a heart-healthy diet are all recommended to slow the progression of stenosis. Regular visits to the doctor are also necessary to monitor progress.

Surgical treatment

Carotid endarterectomy is a surgical procedure to remove the fatty buildup and plaque in the arteries. The surgeon makes an incision in the neck, and the plaque is removed to open up the clogged arteries. The incision is closed either with stitches or a patch. This surgical procedure is often used in severe cases of blockage.

Carotid angioplasty and stenting is another method to remove the blockage from the carotid arteries. This procedure opens the clogged arteries so blood flow to the brain can return to normal. A catheter is used to open the artery and restore blood flow. Stenting with a small metal coil keeps the artery open and decreases the chance of it collapsing. Usually reserved for more severe blockage cases, angioplasty is considered less invasive than a carotid endarterectomy procedure.

How to prevent carotid artery stenosis

Certain risk factors of carotid artery stenosis cannot be controlled, including family history and age. However, many risks are based on lifestyle factors, which means carotid artery stenosis may be prevented or slowed down.

Lifestyle choices such as avoiding smoking and tobacco products, maintaining a healthy weight, living an active lifestyle with regular exercise, and limiting salt and alcohol intake can help prevent or slow down stenosis. Cutting back on fatty and cholesterol-heavy foods may also help.

Living with a blocked carotid artery

Patients with carotid artery stenosis have a higher risk of stroke, which could lead to disability or death. Making lifestyle changes and surgery will lower the risk of stroke due to stenosis.

Although plaque buildup can only be removed through surgery, lifestyle changes like following a heart-healthy diet and regularly exercising can halt or prevent the progression of the carotid artery stenosis.

 Carotid artery stenosis FAQs