Carotid Artery Stenosis

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

UPMC vascular surgeons are experts in treating carotid artery disease. Based on your condition, your doctor will recommend the treatment option — medical management, a minimally invasive procedure, or surgery — that is best for you.

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On this page

• What Is Carotid Artery Stenosis?
• What Are the Symptoms of Carotid Artery Stenosis?
• How Do You Diagnose Carotid Artery Stenosis?
• How Do You Treat Carotid Artery Stenosis?

What Is Carotid Artery Stenosis?

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

Carotid stenosis is a narrowing of one or both of the carotid arteries. These two arteries — located on each side of your neck — 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, it can cause a transient ischemic attack (mini-stroke) or stroke.

How common is carotid artery stenosis?

Carotid artery stenosis is a common condition that is responsible for up to one-third of all strokes. About 1 percent of people will develop carotid artery stenosis between the ages of 50 and 59 years. About 10 percent of people will have the condition between the ages of 80 and 89.

What causes carotid artery stenosis?

Atherosclerosis, also known as hardening of the arteries, is one of the main causes of carotid artery stenosis. Atherosclerosis happens when plaque — which is made up of cholesterol, fats, calcium, and fibrous tissue — accumulates in your arteries.

As you age, plaque continues to build up along your arterial walls. This plaque may narrow the artery or embolize (break free) and travel 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 block a smaller artery.

What are carotid artery stenosis risk factors and complications?

Carotid artery stenosis risk factors

You are more likely to develop carotid artery stenosis as you age. In addition to aging, 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.

Complications of carotid artery stenosis

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 3-4 minutes.

How serious is carotid stenosis?

Carotid stenosis is a serious condition because it increases your risk of stroke. 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.

How can I prevent carotid artery stenosis?

You may not be able to control some of your carotid artery stenosis risk factors, such as aging. However, preventing heart disease and chronic conditions can reduce the risk that you will develop carotid artery stenosis. You may be able to reduce your risk by:

• Eating a diet that is rich in fruits, vegetables, and whole grains.
• Exercising and maintaining a healthy weight.
• Maintaining normal blood pressure and cholesterol levels.
• Avoiding smoking.
• Limiting alcoholic beverages.

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What Are the Signs and Symptoms of Carotid Artery Stenosis?

You may not have any carotid stenosis symptoms until your condition advances. In fact, 80 percent of people are asymptomatic, meaning that they have no symptoms of carotid artery stenosis.

What are the warning signs of a blocked carotid artery?

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.

When should I see a doctor about my carotid artery stenosis symptoms?

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 any symptoms of carotid artery stenosis, call 911 immediately.

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How Do You Diagnose Carotid Artery Stenosis?

Your doctor may be able to diagnose carotid artery stenosis during a physical exam. However, you may need other tests to measure its severity.

What to expect during your visit

During your physical exam, your doctor will:

• Ask about your symptoms, if any, and when they started.
• Discuss your medical history.
• Listen to how your blood flows through your carotid arteries using a stethoscope.

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. If your doctor suspects you may have coronary artery stenosis, they may order additional tests.

Tests to diagnose carotid artery stenosis

To learn more about the extent and severity of your condition, your vascular surgeon may 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 your condition.

Carotid artery stenosis prognosis

Carotid artery stenosis can be dangerous if it’s not caught and treated quickly. This condition can cause a stroke, which can lead to death or disability. Your prognosis and treatment will depend on the amount of blockage in your artery.

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How Do You Treat Carotid Artery Stenosis?

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

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

• If your carotid arteries are less than 80 percent narrowed, your doctor 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 clear and stent the blockage (angioplasty).

Lifestyle changes

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 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.

Medicine to manage carotid artery stenosis

Medication can help you manage other health conditions that may contribute to carotid artery stenosis. 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 for severe carotid artery stenosis

Carotid endarterectomy is the standard treatment for carotid artery disease.

This surgical procedure allows the surgeon to remove the inner lining of the carotid artery that contains the plaque through a small incision in your 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 for severe carotid artery stenosis

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

During this procedure, your surgeon will:

• Inset a small, thin tube called a catheter through a small incision in your groin. The catheter has a balloon at the tip.
• Guide the catheter to the site of the blockage in your neck.
• Inflate the balloon at the tip of the catheter to flatten the plaque and open the artery.
• Place a small metal tube called a stent to help hold your artery open.

How effective is treatment?

Treatment for carotid artery stenosis is effective at reducing stroke risk. UPMC vascular surgeons participate 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.

By UPMC Editorial Staff. Last reviewed on 2024-10-01.