Carotid Artery Disease
Carotid artery disease is a disease in which carotid stenosis is caused by a build-up of plaque inside the artery wall that reduces blood flow to the brain. Carotid stenosis is a narrowing of the carotid arteries. The two major carotid arteries, one on each side of the neck, that carry oxygen-rich blood from the heart to the brain. It is a serious risk factor for stroke and can lead to brain damage.
Carotid stenosis
- It is a process of narrowing of the carotid arteries. Carotid stenosis is a serious risk factor for stroke and can lead to brain damage.
- Normal healthy arteries are flexible and have smooth inner walls. As we age, small injuries to the blood vessel wall and hypertension allows plaque to build up.
- The process of waxy substance (plaque) build-up is called atherosclerosis.
- Plaque is a sticky substance made of fat, cholesterol, calcium, and other fibrous material.
- Plaque deposits inside the inner wall of the artery can form a large mass that narrows the lumen, the inside diameter of the artery.

Atherosclerotic plaque narrows the artery diameter and reducing blood flow.
Symptoms
- Carotid stenosis has no symptoms until the artery becomes strictly narrowed or a clot forms.
- Symptoms are first appearing with a mini-stroke, also known as a transient ischemic attack or TIA.
- TIAs result when blood flow to the brain is temporarily interrupted and then restored. The symptoms typically last a couple of minutes and then resolve completely, and the person returns to normal.
- TIAs are the warning sign of stroke it should not be ignored. They are a warning that an ischemic stroke and permanent brain injury may be looming.
- Symptoms of a TIA or an ischemic stroke can include weakness or numbness in an arm or leg, difficulty speaking, a drooping face, loss of sight in one eyes, ringing in the ears (tinnitus), or paralysis affecting one side of the body.
Diagnosis

Color Doppler ultrasound scan of the carotid arteries
- Carotid stenosis is usually diagnosed by color Doppler ultrasound scan of the carotid arteries in the neck, Computed Tomography Angiogram (CTA) of the neck, Magnetic Resonance Angiography (MRA), or a cerebral angiogram.
- The doctor will examine as much as possible about your symptoms, current and previous medical problems, current medications, and family history.
- The doctor may listen to the carotid artery with a stethoscope to detect a swishing noise known as "bruit."
- A bruit may be a sign of turbulent blood flow caused by atherosclerosis.
- If any of symptoms occurs then doctor refers you to a neurosurgeon for a surgical consultation.
Surgery
Surgical treatment is generally recommended for patients who have suffered one or more TIAs or strokes. The goal of surgery is to prevent stroke by reducing or removing the plaque build-up and expand the artery lumen to allow more blood flow to the brain.
Carotid endarterectomy
- It is a surgical procedure to remove the plaque. A skin incision is made in the neck and the carotid artery is located.
- Temporary clamps are placed across the artery above and below the area of stenosis to stop blood flow.
- During this procedure, the carotid artery on the other side of the neck carries blood flow to the brain.
- The surgeon makes an incision in the artery over the blocked area. The plaque build-up is physically peeled out and removed. The artery is then closed with tiny sutures and the clamps removed to allow blood flow to the brain.
Carotid angioplasty and stenting
- It is a minimally invasive endovascular procedure that reduces the plaque and widens the lumen of the artery.
- It is performed during an angiogram in an interventional radiology suite.
- A flexible catheter is advanced from the femoral artery in the groin, past the heart, and to the location of the plaque within the carotid artery. Next, a small catheter with an inflatable balloon at the tip is positioned across the plaque.
- When the balloon is opened, it dilates the artery and compresses the plaque against the arterial wall. The balloon is then deflated and removed.
- Finally, a self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery.
Carotid artery bypass
- It is a surgical procedure that manages the blood supply around the plaque-blocked area.
- A length of artery or vein is harvested from somewhere else in the body, usually the saphenous vein in the leg or the ulnar or radial arteries in the arm.
- The vessel graft is connected above and below the blockage so that blood flow is rerouted (bypassed) through the graft.
- Bypass is generally used when the carotid is 100% blocked (carotid occlusion).