Carotid artery stenosis (carotid artery disease) is the narrowing of an artery in the neck due to atherosclerosis. Atherosclerosis is a disease characterized by a build-up of fatty material called plaque in the arteries. Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, and pelvis. With carotid artery stenosis, the arteries supplying the brain are affected which can lead to stroke in the following ways:

• The carotid artery may become occluded with plaque, reducing or blocking the blood and oxygen supply to the brain.
• A piece of plaque may break off in the carotid artery and travel to the smaller arteries in the brain, reducing or blocking the blood and oxygen supply to the area of the brain the smaller artery serves.
• If the plaque is perceived by your body as an injury, it will send platelets to help the clotting process and heal the area. Unfortunately, this protective mechanism may lead to an occlusion of the carotid artery by the blood clot (thrombus). In addition, a fragment of the clot may break off and travel to the smaller arteries in the brain (embolus), reducing or completely blocking the blood and oxygen supply to the area of the brain.

Symptoms

• Change in vision: blurred vision, double vision, loss of vision
• Sudden weakness on one side of the face or body
• Numbness or tingling on one side of the face or body'
• Imbalance
• Lack of coordination
• Speaking difficulty: slurred speech, trouble finding words, garbled speech
• Confusion
• Sudden severe headache
• Difficulty swallowing

Who does carotid artery stenosis affect?

• Aging
• Smoking
• Elevated LDL cholesterol and triglycerides
• Diet high in saturated fats
• Obesity
• Elevated blood pressure
• Diabetes
• Physical inactivity
• Family history of atherosclerosis, either coronary artery disease (heart disease) or carotid artery disease

How is carotid artery stenosis diagnosed?

• A carotid bruit (whooshing sound) may be heard directly over the artery during a routine physical exam, indicating stenosis; however this technique is inexact and is strictly used as a screening tool.
• Carotid ultrasound – A non-invasive test used to determine whether the arteries are narrowed or blocked. It also is able to show the movement of blood through the blood vessels.
• Magnetic resonance angiography (MRA) – A test that uses a powerful magnet and radio waves to view the carotid arteries in detail. MRA may be performed with or without contrast. If needed, contrast is injected into a peripheral vein during the test.
• Computerized tomography angiography (CTA) – A minimally-invasive test that uses x-ray equipment. A contrast material is injected into a peripheral vein during the test to produce highly detailed images of both blood vessels and tissue.
• Cerebral angiography – This procedure is considered the “gold standard” test when diagnosing carotid artery stenosis; however, it is used less often because it is more invasive. It involves injecting contrast into the carotid arteries while x-ray images are being taken. This procedure allows the doctor to visualize the blood flow through the carotid arteries in real time. 

How is carotid artery stenosis treated?

• Medical management – Often includes antiplatelet therapy (aspirin, Plavix, Aggrenox), excellent control of blood pressure and diabetes, cholesterol medications if needed, smoking cessation, and management of atrial fibrillation if present.
• Carotid endarterectomy (CEA) – A surgical procedure that involves making an incision in the neck and directly removing the plaque in the affected portion of the carotid artery. The artery is then sutured closed.
• Carotid artery stenting (CAS) – A procedure that involves inserting a catheter through the femoral artery in the groin and advancing it until it reaches the affected portion of the carotid artery. Once the narrowing is detected, a stent is used to widen the opening. At NeuroTexas Institute, an umbrella-shaped device is inserted prior to the stent so that any fragments that may separate during the procedure are caught before reaching the brain.

The NeuroTexas Institute utilizes two advanced, specialized neurosurgical operating suites and provides cutting-edge treatment options for neurovascular and endovascular disorders. To learn more about the Cerebrovascular – Stroke Program at NeuroTexas Institute, click here.

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