Carotid artery stenosis is plaque buildup in neck arteries that can lead to stroke. It can cause serious blockages if untreated.
What is carotid artery stenosis?
Carotid artery stenosis is a cerebrovascular condition marked by fatty buildup (cholesterol and other tissues called plaques) in the carotid arteries of the neck. As this buildup grows, the arteries become clogged and can’t get blood to the brain as well as they should. Stenosis is a medical term that describes the abnormal narrowing of a body passageway, such as a blood vessel, a valve, a duct, or other tubular structures. This narrowing can restrict the flow of blood, other fluids, or even nerve impulses, depending on where it occurs. If left untreated, carotid artery stenosis can lead to a severe or complete blockage in these vessels, causing a stroke or transient ischemic attack.
AHN Stroke Centers
AHN Stroke Centers are dedicated to using the latest in clinical advancements to provide expert and efficient stroke treatment that is personalized to our patients’ needs. AHN Stroke Centers are equipped to handle the most complex stroke cases and has protocols in place for rapid diagnosis and advanced neurosurgical or endovascular interventions. No matter the time or day, our neurologists are on call for emergency procedures to ensure you are met with the care you need, when you need it.
Why choose AHN for your carotid artery stenosis?
At AHN, our experienced neurologists and neurosurgeons tailor care to your needs. We offer the latest therapies and design personalized care plans to effectively treat carotid artery stenosis. Our multidisciplinary team of neurologists, neurosurgeons, specialized heathcare providers, and rehabilitation therapists work together to coordinate your care. A strong, coordinated team helps you receive the best care from the first medical intervention through rehabilitation, which maximizes your chances for independence.
AHN Stroke Centers in western Pennsylvania and Erie provide a fast and accurate stroke diagnosis and create a personalized stroke treatment plan for the patients. Our stroke team includes board-certified neurologists, neurosurgeons, and specialists who work together to deliver the most effective stroke treatment for each patient.
Several AHN Stroke Center locations have received advanced stroke center certifications by The Joint Commission, designations that recognize the top-level care we provide for even the most complex stroke conditions.
Carotid artery stenosis symptoms and signs
Narrowing (stenosis) of the carotid arteries (located in your neck) is frequently caused by carotid artery disease, a type of cerebrovascular disease. Cerebrovascular disease is a broad term that refers to a group of conditions that affect the blood vessels and blood supply to the brain. These conditions can cause brain damage by disrupting the normal flow of blood, leading to a lack of oxygen and nutrients to brain cells. This condition often develops over many years, with few or no symptoms.
If someone shows physical symptoms, they could be experiencing a transient ischemic attack (TIA). With both a stroke and a TIA, a blood vessel blockage prevents blood and oxygen from reaching your brain. Unlike a stroke, however, a TIA only blocks blood flow for a short time. Symptoms are similar to stroke symptoms but go away on their own. A TIA is still a significant health event that should be taken seriously. If you have experienced any of the following symptoms, it’s critical you speak with your doctor.
Someone with a TIA may experience sudden but short-lived:
- Numbness or weakness, on one or both sides of the body
- Vision changes, such as blurriness or vision loss
- Paralysis
- Facial droop
- Problems speaking
Causes and risk factors
Carotid artery stenosis occurs when one or both of the primary blood vessels in your neck, responsible for delivering blood to your brain, become constricted. This constriction typically arises from the gradual buildup of fatty deposits and other substances within the arterial walls. This can cause damage to the arteries and lead to health conditions including:
- High blood pressure
- High cholesterol
- Diabetes
- Inflammation
These conditions can increase the risk of carotid artery stenosis due to the reduced blood flow. Talk with your doctor to ensure that the proper monitoring takes place so your risk can be assessed.
Carotid artery stenosis screening and diagnosis
Because many patients feel no symptoms, physicians often first identify carotid artery stenosis through routine medical testing. Sometimes doctors may suspect this condition when they hear certain sounds while listening to your neck with a stethoscope.
If your physician suspects you have carotid artery stenosis, you may need other tests to confirm a diagnosis. These tests may include:
- Carotid artery ultrasound scans evaluate how well blood flows through the carotid arteries.
- CT (computed tomography) or MRI (magnetic resonance imaging) scans provide detailed images of the affected arteries and potential blockages.
- Catheter angiogram uses X-ray imaging and a special dye to take detailed images of inside the blood vessels.
Types and stages of carotid artery stenosis
To better understand your condition and treatment options, it's helpful to know about the different ways carotid artery stenosis is classified. The different types and stages are:
- Internal carotid artery stenosis: This is the most clinically significant type. The internal carotid arteries (one on each side of the neck) are the primary blood supply to the brain. Stenosis here is a major concern because it directly impacts blood flow to the brain, significantly increasing the risk of stroke. When doctors discuss carotid artery stenosis and its treatment, they are almost always referring to stenosis in the internal carotid artery.
- External carotid artery stenosis: The external carotid arteries supply blood to the face, scalp, and neck structures (like muscles and glands). Stenosis in the external carotid artery is generally less critical than internal carotid stenosis because it does not directly affect blood flow to the brain. While it can cause symptoms, it rarely leads to stroke.
Carotid artery stenosis stages
Carotid artery stenosis is generally staged based on the degree of narrowing (stenosis) in the carotid artery. This is typically measured as a percentage. The stages often guide treatment decisions:
- Mild stenosis: This usually refers to less than 50% narrowing of the artery. At this stage, symptoms are rare, and treatment often focuses on managing risk factors like high blood pressure, high cholesterol, and diabetes, along with recommending lifestyle changes (like a healthy diet and exercise).
- Moderate stenosis: This typically means 50% – 69% narrowing. At this stage, monitoring becomes more critical, and medication to prevent blood clots (like aspirin) might be recommended. Some patients in this range, especially those with symptoms, might be considered for intervention.
- Severe stenosis: This is defined as 70% or greater narrowing of the artery. Patients with severe stenosis, particularly if they have experienced symptoms like a TIA or stroke, are at a much higher risk of stroke. These patients are often candidates for more aggressive treatments like carotid endarterectomy (removing plaque) or placing a stent (mesh tube) to clear the blockage.
- Occlusion: This is a complete blockage (100% narrowing) of the carotid artery. Once an artery is completely occluded, surgical intervention to open it is usually not possible, as the blood flow has ceased. Treatment then focuses on managing symptoms and preventing stroke from other sources.
Understanding these stages is key to effective care. At AHN, our compassionate team is here to support you every step of the way with expert diagnosis and treatment tailored to your unique needs.
B.E. F.A.S.T
Knowing the signs of stroke can save a life. Always B.E. F.A.S.T and look for physical changes:
B: Balance
E: Eyes
F: Face drooping
A: Arm weakness
S: Speech difficulty
T: Time to call 911
Carotid artery stenosis treatment
Carotid artery stenosis treatment depends on the severity of the blockage and the risk it poses to you. Learn more about AHN’s system of cerebrovascular and stroke care.
Improving your diet and exercise habits may be enough to stop your condition from worsening. Lifestyle adjustments that focus on getting regular movement and a balanced diet can be effective in managing or reducing the effects of carotid artery stenosis.
Your physician may prescribe medications such as blood thinners, blood pressure-lowering medications, and cholesterol-lowering medications to further reduce your risk of having a stroke.
If the stenosis has advanced far enough, physicians may recommend a surgical procedure to remove the buildup from the affected artery. At AHN, our cerebrovascular team performs the latest techniques to treat carotid artery disease:
- Carotid endarterectomy: A physician makes an incision into the affected artery and carefully removes the plaque and other affected areas, if necessary.
- Carotid angioplasty with stenting: A physician uses a catheter (a tiny, hollow tube) and special tools, including a balloon that helps widen the artery. Then the physician places a mesh stent in the artery to keep it from closing.
- Transcarotid artery revascularization (TCAR): TCAR is a minimally invasive procedure that involves a small incision at the base of the neck to access the carotid artery. A temporary blood flow reversal system is used to protect the brain from plaque fragments during the stenting procedure.
Carotid artery stenosis FAQs
Questions about carotid artery stenosis are common, and AHN is here to provide answers. Your care team is available to talk with you to discuss any questions or concerns. Having trusted background information can help guide your conversations so you feel confident and prepared. These are some of our patients’ most frequently asked questions about carotid artery stenosis.
What is the best treatment for carotid artery stenosis?
The best treatment for carotid artery stenosis is highly individualized and depends on several factors, including the severity of the narrowing, whether you've experienced symptoms (like a TIA or stroke), your overall health, and other risk factors. Generally, treatments fall into three main categories:
- Lifestyle modifications and medical management: This is the foundation of treatment for all degrees of stenosis, and for managing underlying atherosclerosis. It includes:
- Medications: To control blood pressure, lower cholesterol (e.g., statins,) and manage diabetes, and antiplatelet drugs (like aspirin) to prevent blood clots.
- Lifestyle changes: Quitting smoking, adopting a heart-healthy diet, getting regular exercise, and managing weight.
- Carotid endarterectomy (CEA): CEA is a traditional procedure where a surgeon makes an incision in the neck, opens the carotid artery, and removes the plaque buildup directly.
- Carotid artery stenting (CAS): This less invasive procedure involves inserting a catheter, usually from a large blood vessel in the groin or arm, and guiding it to the narrowed carotid artery. A balloon is then inflated to open the artery, and a small mesh tube (stent) is placed to keep it open.
Your doctor will carefully weigh the risks and benefits of each option to determine the most appropriate and effective treatment plan to address your needs.
How serious is carotid artery stenosis?
Carotid artery stenosis is a serious condition because it significantly increases your risk of having a stroke. A stroke occurs when blood flow to part of the brain is interrupted, leading to brain damage and potentially long-term disability or even death. The seriousness of carotid artery stenosis depends on:
- Degree of narrowing: The more narrowed the artery, the higher the risk. Severe stenosis (70 – 99% blockage) carries a much higher risk of stroke than mild stenosis.
- Presence of symptoms: If the stenosis has already caused a health event like a transient ischemic attack (TIA) or a stroke, it requires urgent medical attention, as your risk of a future, more serious stroke is increased.
- Plaque characteristics: Some plaques are more unstable and prone to breaking off or forming clots, regardless of the exact percentage of narrowing.
- Overall health: Other coexisting health conditions, like diabetes, high blood pressure, and heart disease, can further increase the risk associated with carotid artery stenosis.
While the diagnosis can be alarming, it's important to remember that it's also a treatable condition. With proper management and, if necessary, intervention, the risk of stroke can be significantly reduced.
What is carotid artery stenosis also known as?
While "carotid artery stenosis" is the most precise and commonly used medical term, you might also hear it referred to by some related or descriptive names, such as:
- Carotid artery disease: This is a broader term that encompasses the underlying condition of atherosclerosis (buildup of plaque) affecting the carotid arteries, which then leads to stenosis.
- Carotid stenosis: A shortened version of the full term.
- Narrowing of the carotid artery: A descriptive, nonmedical way to explain the condition.
- Atherosclerosis of the carotid arteries: This emphasizes the primary cause, which is the buildup of plaque due to atherosclerosis.
- Carotid occlusive disease: This term might be used if the artery is severely blocked or 100% occluded.
Regardless of the specific term used, they all point to the same fundamental problem: The critical arteries supplying blood to your brain are narrowing, primarily due to plaque buildup.
Can you live a normal life with carotid artery stenosis?
Yes, many people with carotid artery stenosis can live long and healthy lives, often without experiencing a stroke. The key to living a normal life with this condition lies in:
- Effective management: Adhering to your treatment plan, which typically includes medications to control risk factors (like blood pressure and cholesterol), antiplatelet drugs, and healthy lifestyle changes (quitting smoking, healthy diet, regular exercise).
- Regular monitoring: Regular checkups and imaging studies (like carotid ultrasound) to monitor the degree of stenosis and plaque stability.
- Timely intervention (if needed): If your doctor determines that an intervention like carotid endarterectomy or stenting is necessary, undergoing the procedure can significantly reduce your stroke risk.
- Awareness: Knowing the signs of stroke (B.E. F.A.S.T.) and seeking immediate medical attention if they occur is crucial.
While a diagnosis of carotid artery stenosis requires ongoing attention and management, it does not automatically mean a diminished quality of life. By actively participating in your care and working closely with your healthcare team, you can effectively manage the condition and maintain a full, active life.
Contact us
To schedule an appointment or learn more about AHN Neuroscience Institute, call 412-359-6200 in Pittsburgh or 814-452-7575 in Erie.
If you're an existing patient, you can also call (412) DOCTORS 412-62-8677 in Pittsburgh or 814-CONNECT in Erie or make an appointment with a specialist with AHN Neuroscience.