Carotid Artery Stenosis

As plaque builds up in the carotid arteries over time, it can lead to narrowing and eventually restrict blood flow to the brain. Carotid artery stenosis is a common cause of stroke. However, it is possible to have the condition and no symptoms at all.

What Is Carotid Artery Stenosis?

The carotid arteries are the two large blood vessels along each side of the neck (the pulse under your jawline). They provide the blood supply needed for oxygen to most of the brain and eyes. Stenosis means a narrowing or constriction in one or more passages within the body. Carotid artery stenosis occurs when the blood flowing through the main artery to the brain is narrowed or blocked.

What Causes Carotid Artery Blockage?

Narrowed or blocked carotid arteries are usually caused by atherosclerosis, a condition characterized by plaque buildup of fat, cholesterol, calcium and other substances in the blood. Too much plaque eventually narrows or hardens the arteries. Over time, pieces of plaque can break off and flow into the bloodstream, slowing or blocking blood flow to the eyes and brain.

Various factors can cause atherosclerotic plaque to form in the carotid arteries, including:

• Genetics
• High cholesterol
• Smoking
• Fatty diet
• Physical inactivity

Carotid artery stenosis is a chronic condition that affects people as they age. There are some cases when radiation treatment can cause some patients to develop carotid artery stenosis and not atherosclerosis. Some inflammatory conditions can cause irregularities in the carotid arteries as well.

What Are the Symptoms of a Blocked Carotid Artery?

Carotid artery stenosis can develop undetected and is often found by accident. If the narrowing causes symptoms, it can lead to transient ischemic attack (TIA) or stroke. Although TIA has similarities with stroke, it does not cause permanent damage to the brain. It cannot be found in a magnetic resonance imaging (MRI) or computerized tomography (CT) scan.

Use the F.A.S.T. acronym to help you recognize the most common signs and symptoms of a TIA or stroke according to the American Heart Association:

Face Drooping – Does one side of the face droop, or is it numb? Ask the person to smile. Is the person’s smile uneven?

Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?

Speech Difficulty – Is speech slurred?

Time to call 911

Watch for other stroke symptoms, such as sudden:

• Numbness or weakness of the face, arm or leg, especially on one side of the body
• Confusion, trouble speaking or understanding speech
• Trouble seeing in one or both eyes
• Difficulty walking, dizziness, loss of balance or coordination
• Severe headache with no known cause

What Percent of Carotid Artery Blockage Requires Surgery?

The person’s symptoms and the amount of blockage in the carotid artery will determine the appropriate treatment for carotid artery stenosis. Treatment options range from medicines to opening the blood vessel with surgery. To diagnose carotid artery stenosis, your doctor will ask you about any warning signs you may be experiencing and order imaging tests to gauge the severity of the plaque buildup.

• If the narrowing of the carotid artery is less than 50%, with or without symptoms, your doctor may recommend medication.
• If the narrowing of the carotid artery is between 50% and 70% and you have symptoms, your doctor may consider surgery in some cases.
• If the narrowing of the carotid artery is more than 70% and you are having symptoms, your doctor may recommend surgery.
• If the narrowing of the carotid artery is more than 70% and you do not have other symptoms, your doctor may recommend surgery if there is a low risk of complications.

Is Carotid Artery Surgery Dangerous?

There are two surgical procedures to treat patients with carotid artery stenosis:

• In stenting, the surgeon performs the procedure using a tube that runs from the groin to the neck. The surgeon inserts a metal stent in the artery through the tube to lessen the narrowing.
• In carotid endarterectomy, the surgeon makes an incision in the neck to remove the plaque buildup on the inside of the artery.

Both procedures increase a person’s risk of stroke during the operation. Ultimately, the best treatment will depend on the patient’s condition and unique needs. Ask your doctor for information to help you make an informed decision. Some points to discuss with your provider include studies backed up by good data, the possible risks and benefits of surgical options for carotid artery stenosis, the cost of these treatments and whether your insurance covers the costs.

Recommendations

Plaque buildup in the carotid artery is a crucial indicator of future risk of cardiovascular disease. If you have received a carotid artery stenosis diagnosis, healthy lifestyle changes can help improve your health outcomes. Some of the lifestyle modifications to consider are:

• Stop smoking to prevent further damage to your artery walls.
• Eat a low-saturated fats diet to reduce cholesterol buildup and plaque formation. A balanced diet can help decrease the incidence of obesity and high blood pressure.
• Engage in moderate exercise for 30 minutes a day.
• Help lower your blood pressure and prevent aggravating stress-related damage to the arteries through stress reduction techniques.