Carotid Artery Stenosis

UPMC Content 2

Contact the UPMC Heart & Vascular Institute

Request an appointment online, call 1-855-UPMC-HVI (876-2484), or email us.

Carotid artery stenosis, or narrowing of the carotid arteries in the neck, is a leading cause of stroke.

Vascular surgeons at the UPMC Heart and Vascular Institute are the best specialists to assess carotid artery disease and determine which treatment option — medical management, minimally invasive procedures, or surgery — is best for you.

What Is Carotid Artery Stenosis?

At the UPMC Heart and Vascular Institute, we take a team approach to provide comprehensive care for people with carotid artery stenosis. We will work with you and your primary care doctor to create a plan of care that is tailored to you.

Arteries are blood vessels that carry oxygen- and nutrient-rich blood to your body's tissues.

Carotid stenosis is described as a narrowing of one or both of the carotid arteries. These are the two arteries — located on each side of your neck — that deliver oxygen to the front portion of your brain.

When arteries become narrow, less blood flows through them.

If the carotid arteries become too narrowed, or blocked, a transient ischemic attack (mini-stroke) or stroke can result.

Causes of carotid artery stenosis

Atherosclerosis results when plaque — which is made up of cholesterol, fats, calcium, and fibrous tissue — accumulates in arteries.

As one ages, plaque continues to build up along the arterial walls. This plaque may narrow the artery or embolize (break free) to the brain causing a stroke or mini-stroke.

Also, a blood clot can develop in an area where plaque builds up. A part of a clot can break away and become lodged in a smaller artery.

What is atherosclerosis?

Atherosclerosis — also called “hardening of the arteries” — is often the source of carotid artery stenosis.

Carotid artery stenosis risks

You are more likely to develop carotid artery stenosis as you age. To better prevent these chances, you may want to consider scheduling an appointment for a heart disease screening.

  • About 1 percent of people will develop a carotid artery stenosis between ages 50 and 59 years.
  • About 10 percent of people will have the condition between the ages of 80 and 89.

In addition to age, other risk factors for carotid artery stenosis and atherosclerosis include:

  • High cholesterol level (especially elevated LDL or "bad" cholesterol)
  • Poorly controlled high blood pressure
  • Tobacco use
  • Poorly controlled diabetes
  • Obesity
  • Lack of exercise
  • Family history
  • Cardiac disease

Carotid artery stenosis complications

If not treated, carotid artery stenosis can lead to a TIA (mini-stroke) or a stroke.

A stroke happens when blood flow is cut off to a portion of the brain. Without blood flow, brain tissue can die within three to four minutes.

Strokes may cause long-term brain damage, disability, and even death.

TIA symptoms and signs may clear within a few minutes to a few hours. People who experience them are at much higher risk of having additional TIAs and a stroke.

That's why it's important to have a doctor closely manage any carotid blockage.

For an appointment with a vascular specialist at the UPMC Heart and Vascular Institute, complete an appointment request form or call 1-855-UPMC-HVI (876-2484).

Carotid Artery Stenosis Symptoms and Diagnosis

Carotid artery stenosis symptoms

You may not have any symptoms of carotid stenosis until your condition develops into an advanced state. In fact, most people (80 percent) are asymptomatic, or have no symptoms of carotid stenosis.

One of the first symptoms of a blocked carotid artery that you may experience could be a transient ischemic attack (also called a TIA or mini-stroke) or a stroke.

Symptoms of a TIA include:

  • Weakness, numbness, or tingling on one side of your body (one arm and/or leg).
  • Loss of movement of one arm or leg.
  • Partial vision loss in one eye (often described as a window shade being pulled down).
  • Inability to speak clearly or express your thoughts.

It is difficult to determine if you are having a mini-stroke (TIA) or a full stroke. Therefore, you should consider both medical emergencies.

If you or someone you know experiences these symptoms, call 911 immediately.

Diagnosing carotid artery stenosis

Your doctor may suspect carotid artery stenosis if he or she hears an abnormal sound called bruits (broo-ees) while listening to blood flowing through your carotid arteries with a stethoscope.

To obtain a better understanding of the disease process, UPMC's vascular surgeons use ultrasound — a painless imaging test — to determine:

  • If you have carotid artery stenosis.
  • How bad it is.
  • Your risk of stroke.

If you have high-grade stenosis, or symptoms of TIA or stroke, you should see a vascular surgeon to decide how to best treat this condition.

For an appointment with a vascular specialist at the UPMC Heart and Vascular Institute, complete an appointment request form or call 1-855-UPMC-HVI (876-2484).

Carotid Artery Stenosis Treatment

The primary goal of treating carotid stenosis is to prevent a stroke.

The type of personalized treatment you will receive depends on several factors, including how narrow the arteries are.

If your carotid arteries are less than 80 percent narrowed, your doctor at the UPMC Heart and Vascular Institute may recommend lifestyle changes, risk factor modification, and medications.

If your carotid arteries are more than 80 percent narrowed, your doctor may recommend a surgical procedure to clean out the artery (endarterectomy) or a minimally invasive procedure to stent the blockage (angioplasty).

Lifestyle changes and medication

If you do not have any symptoms and your doctor determines that you have a low risk of stroke, he or she may recommend lifestyle changes and medication to control the factors that contribute to plaque build-up in the carotid arteries.

Lifestyle changes include:

  • Decreasing LDL (bad) cholesterol levels in your blood and increasing HDL (good) cholesterol levels.
  • Lowering high blood pressure.
  • Controlling blood sugar if you have diabetes.
  • Eating a heart-healthy diet.
  • Quitting tobacco use.
  • Exercising.
  • Losing weight.
  • Limiting alcohol intake.

Medications your doctor may prescribe include:

  • Statins, to control cholesterol levels.
  • Blood pressure medications, such as diuretics and beta blockers.
  • Antiplatelet medications, such as aspirin and clopidogrel.

Carotid endarterectomy or angioplasty for severe blockage

Carotid endarterectomy is the standard treatment for carotid disease.

This surgical procedure allows the surgeon to remove the inner lining of the carotid artery that contains the artherosclerotic plaque through a small incision in you neck.

If you need a carotid endarterectomy, UPMC vascular surgeons have performed thousands of these procedures. We generally discharge most patients the day after the procedure, with little risk for long-term complications.

Carotid angioplasty and stenting is a minimally invasive procedure that your vascular surgeon may recommend if occlusion or stenosis of the artery occurs. It allows your vascular surgeon to use x-ray imaging to guide a balloon-tipped catheter to the blockage.

It requires to use catheters to open a blockage of the carotid artery in the neck through a puncture site in the groin. They may also use a stent to help hold the artery open.

Once in place, the surgeon inflates and deflates the balloon, which flattens the plaque and opens the artery.

To keep the carotid artery open, your surgeon may also insert a stent. A stent is a tiny, metal device that attaches to the arterial wall and serves as a brace to keep the artery open.

UPMC vascular surgeons are involved in extensive research to determine what type of patient benefits from each procedure. We will recommend the right treatment for your unique circumstances, and will work with you and your primary care doctor to ensure the long-term success of your treatment.

For an appointment with a vascular specialist at the UPMC Heart and Vascular Institute, complete an appointment request form or call 1-855-UPMC-HVI (876-2484).

Carotid Artery Stenosis Educational Materials

The UPMC Heart and Vascular Institute offers educational information and videos about carotid artery stenosis and other heart and vascular diseases and treatments.

Many people find these resources helpful in answering their questions about their condition and preparing them for their procedure or diagnostic test.

The links below will open a new browser window.

UPMC Patient Education Materials

Emmi ™ Patient Education Videos

From the Society for Vascular Surgery

To make an appointment with a vascular specialist at the UPMC Heart and Vascular Institute, complete an appointment request form or call 1-855-UPMC-HVI (876-2484).