Carotid Artery Disease

Symptoms occur when the narrowing becomes severe enough to restrict blood flow to the brain, causing a stroke or TIA. Symptoms of these events include:

• Sudden numbness or weakness in the face or limbs, typically on one side of the body.
• Sudden difficulty speaking or understanding speech.
• Sudden vision problems in one or both eyes.
• Sudden dizziness or loss of balance.
• Sudden severe headache with no known cause

Seek emergency care for any stroke symptoms, even if they are brief and resolve quickly, as they might indicate a TIA (transient ischemic attack) also known as a “mini-stroke” which can be a warning sign that a stroke may happen. Consult a healthcare provider if you have risk factors for carotid artery disease, even without symptoms, to manage risks and prevent the progression of the disease. 

Carotid artery disease is caused by a buildup of plaques in the arteries leading to the brain, a condition known as atherosclerosis. Plaques consist of cholesterol, fat and blood cells. They narrow the arteries, restricting the flow of oxygen and nutrients to the brain.

Numerous factors increase the risk of carotid artery disease:

• Tobacco use: Nicotine irritates artery linings and raises heart rate and blood pressure.
• High blood pressure: Excessive pressure can damage artery walls.
• Diabetes: Impairs fat processing, increasing blood pressure and atherosclerosis risk.
• High blood-fat levels: Elevated cholesterol and triglycerides contribute to plaque buildup.
• Family history: Higher risk if a relative has atherosclerosis or coronary artery disease.
• Obesity: Increases the likelihood of high blood pressure, atherosclerosis and diabetes.
• Lack of exercise: Contributes to high blood pressure, diabetes and obesity
• Age: Arteries lose flexibility and are more prone to damage over time. 

Carotid artery disease is responsible for 10% to 15% of strokes, which can lead to brain damage, muscle weakness and potentially death.  

• Reduced blood flow: Severe artery narrowing limits blood reaching the brain.
• Ruptured plaques: Broken-off plaque fragments can block smaller brain arteries.
• Blood clot blockage: Plaques can crack, and blood clots can form quickly at the sight of the crack and obstruct blood flow. 

Diagnosis involves a medical history and physical exam as well as testing with a variety of test modalities. Carotid artery disease may not cause symptoms until the blockage or narrowing is severe.  

In patients without symptoms one sign that can arise is detected by your doctor on physical examination. When listening with a stethoscope, a bruit (whooshing sound) might be heard over the carotid artery. This sound arises from turbulent blood flow through the narrowed portion of the artery. The presence and severity of the narrowing can then be determined using one or more of the imaging tests outlined below:

• Ultrasound: This test uses sound waves to image the arteries and to evaluate blood flow and estimate pressures in the carotid arteries. This test is safe, highly effective and the most common test ordered when carotid disease is suspected by either a history of suspicious symptoms, physical exam findings or both.  
• CT angiography or MR angiography: These more advanced imaging techniques use contrast dye and can provide more detailed images of the blockages and blood flow in the carotid arteries  
• CT or MRI (of the brain):  In addition to imaging a narrowed carotid artery directly, your doctor may need to image your brain separately using CT or MRI.  Damage of the brain tissue, both from old and new strokes, can be quickly and accurately determined using either or both tests.  

Carotid artery disease prevention is vital because it can significantly reduce the risk of stroke, which can lead to severe disability or death. Preventive measures, such as maintaining a healthy lifestyle and managing existing health conditions, help keep the arteries clear and functioning properly. By taking steps to prevent carotid artery disease, individuals can avoid the potentially devastating effects of a stroke, improve their overall cardiovascular health and enhance their quality of life.  

Early intervention and regular health screenings can catch the disease in its early stages, allowing for timely and effective treatment. Preventive measures include: 

• No smoking: Reduces stroke risk to that of non-smokers within a few years.
• Maintain a healthy weight: Reduces the risk of related conditions.
• Healthy diet: Focus on fruits, vegetables, whole grains, and lean proteins, while limiting unhealthy fats and cholesterol.
• Limit salt: Helps manage blood pressure.
• Regular exercise: Lowers blood pressure, improves cholesterol levels and promotes overall vascular and heart health.
• Moderate alcohol consumption: Up to one drink a day for women and two for men.
• Control illnesses: Managing conditions like diabetes and high blood pressure protects arteries.

Carotid artery disease is a serious condition caused by the buildup of fatty deposits in the carotid arteries, which can lead to strokes—a major cause of death and disability. Early detection and management are crucial, as the disease often progresses without noticeable symptoms until a stroke or TIA occurs. Understanding the risk factors, such as high blood pressure, smoking, diabetes and lack of exercise, can help in taking preventive measures. Treatment options range from lifestyle changes and medications to surgical procedures, depending on the severity of the blockage. Regular check-ups and proactive management of health conditions can significantly reduce the risk of complications from carotid artery disease.