Carotid stenosis is narrowing of the carotid artery, which supplies the brain, due to atherosclerosis. It is an important cause of stroke and transient ischaemic attacks; treatment options include medication, carotid endarterectomy and stenting.
What is carotid stenosis?
The carotid arteries on each side of the neck carry blood to most of the brain. With age, fat and calcium can build up in the vessel wall (atherosclerosis, or hardening of the arteries) and narrow these arteries. Fragments or clots breaking off from the plaque can block brain vessels and cause a stroke.
Risk factors
- Older age
- Smoking
- High blood pressure
- Diabetes
- High cholesterol
- Coronary artery disease and a family history of vascular disease
Symptoms
Carotid stenosis usually causes no symptoms. When it does, it typically presents as a transient ischaemic attack (TIA, "mini-stroke") or a stroke:
- Sudden weakness or numbness of the face, arm or leg (usually on one side)
- Sudden speech disturbance
- Sudden, temporary loss of vision in one eye ("a curtain coming down")
Even if symptoms resolve quickly, urgent assessment is necessary.
Diagnosis
Initial assessment is with Doppler ultrasound of the neck arteries. The degree of narrowing and the structure of the plaque are examined in detail with CT angiography, MR angiography or, if necessary, digital subtraction angiography. Brain MRI can be used to look for previous silent strokes.
Treatment Approach
- Medication and risk-factor control: Antiplatelet drugs, cholesterol-lowering medication, control of blood pressure and blood sugar, and stopping smoking are the foundation of treatment for all patients.
- Carotid endarterectomy: Through an incision in the neck, the artery is opened and the plaque removed. It is performed in selected patients with symptoms and significant narrowing to reduce the risk of stroke.
- Carotid stenting: A stent is placed in the narrowed segment from inside the artery. It may be preferred for some patients at high surgical risk.
The decision to intervene takes into account the degree of narrowing, whether there have been symptoms, the patient's age and other medical conditions.