What is Carotid Artery Disease?

The carotid arteries are the two major arteries in the neck, located on either side of the windpipe, that provide most of the blood supply to the brain. Over time, these arteries may become narrowed or blocked due to a process called atherosclerosis or "hardening of the arteries". The buildup may obstruct the blood flow to the brain, leading to a stroke or a "mini" stroke (TIA).

Carotid artery disease is the cause of more than half of all strokes. Stroke, in turn, is the third highest cause of death and the leading cause of disability in the United States.

Why carotid stenosis occurs in some people but not others is unknown. However, certain risk factors, such as family history, high blood pressure, high cholesterol, heart disease, diabetes, smoking, and obesity, predispose some people to the condition.

How is Carotid Artery Disease Diagnosed?

In some cases, the first symptoms of carotid artery disease may be a stroke or a mini stroke called Transient Ischemic Attack (TIA). Symptoms of a stroke or TIA may include:

• Numbness in the arms or legs, especially when limited to one side of the body
• drooping of one side of the face
• confusion
• difficulty speaking or understanding speech
• a sudden episode of memory loss
• difficulty seeing from either one or both eyes
• disorientation or disturbance in coordination
• severe headache

The temporary presence of these symptoms (a few minutes or hours) indicates a 'mini' stroke (TIA). Symptoms lasting over 24 hours indicate more permanent damage due to a stroke.

Blockage (stenosis) of the carotid arteries can also occur without any signs or symptoms. This is called asymptomatic stenosis and it predisposes the patient to having a stroke. Asymptomatic stenosis in the carotid arteries is sometimes discovered during a routine examination, when a "bruit," a swishing sound, is heard through a stethoscope placed on the neck in the area over the artery. A bruit generally indicates a significant level of stenosis in the artery.

When your doctor suspects that you have a significant degree of stenosis in your carotid arteries, she or he will conduct an examination consisting of specific tests. These may include:

• Duplex ultrasound
• Cerebral angiogram
• Magnetic Resonance Angiogram (MRA)
• CT scan

How is Carotid Artery Disease Treated?

Mild carotid artery disease can sometimes be treated with medication and risk factor modification such as smoking cessation and reduction of cholesterol levels, and monitored for progression to a more severe form.

More severe disease is usually treated with an operation called carotid endarterectomy. In certain individuals a minimally invasive procedure called carotid stenting may be possible.