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Carotid artery stenosis

Carotid artery disease occurs when waxy, fatty deposits called plaques clog one or both of your carotid arteries. These two arteries – one located on each side of your neck – are the main blood vessels that carry blood to your brain. The plaque buildup gradually narrows or blocks the arteries and decreases blood flow to the brain, which greatly increases the chance of stroke.

Symptoms

Most patients do not show any symptoms. Instead, it is typically recognized during a routine medical exam when your physician listens to the blood flow through your artery with a stethoscope. If a patient does experience any symptoms, it’s usually a transient ischemic attack (TIA), which can cause numbness or weakness on one or both sides of your body, paralysis, loss of consciousness, blurred vision or a brief loss of vision in one eye and slurred speech.  If a permanent deficit occurs, the patient has had a stroke.

Diagnosis

Carotid artery duplex scan is a non-invasive ultrasound test that evaluates your carotid arteries’ blood flow. A probe called a transducer is placed on your skin above the carotid arteries at certain locations and angles. The ultrasonic sound waves from the transducer move through your skin and other body tissues to the blood vessels, where the waves echo off of the blood cells. The transducer picks up the reflected waves and sends them to an amplifier, which makes the ultrasonic sound waves audible. Absence or faintness of these sounds may indicate an obstruction to the blood flow.

Computed tomography (CT or CAT) scan is a test that involves taking a series of X-rays from many different angles and then processing them using computer technology. The process produces clear and extremely detailed images of your aorta.

Cardiac MRI (magnetic resonance imaging) is a painless test that uses no radiation and provides physicians with extremely detailed, 3-D still and moving pictures of your heart’s structure and functions. Viewing your heart in motion, allows our doctors to clearly see the chambers, valves and blood vessels and diagnose any potential medical conditions. You lie on a table and are guided inside a large tube while magnets inside the tube pass around your body and obtain images.

Computed tomography angiogram (CTA) is a test that uses X-ray imaging to view inside your heart’s blood vessels. It involves injecting a radioactive dye into your bloodstream through an intravenous (IV) line. The dye is visible on a special scanner machine and shows images of your blood vessels. The machine then takes several detailed pictures, called angiograms, of the blood vessels and provides doctors with evidence of any heart conditions.

Magnetic resonance angiogram (MRA) is a diagnostic procedure that uses a combination of magnetic resonance technology (MRI) and intravenous (IV) contrast dye to visualize blood vessels. Contrast dye causes blood vessels to appear opaque on the MRI image, allowing the doctor to visualize the blood vessels being evaluated.

Treatments

Medications such as cholesterol-reducers, blood thinners or blood pressuring lowering medicines are prescribed to reduce the risk of stroke.

Carotid endarterectomy is the preferred surgical treatment to remove plaque and clots from carotid arteries. It is performed using general anesthetic, and involves a surgeon making an incision in your neck at the location of the blockage. The surgeon opens your carotid artery, removes the plaque and any other diseased portions, and sews your artery back together to allow blood flow to the brain.

Carotid angioplasty with stenting is an option for a patient who is not an appropriate candidate for an endarterectomy. It is a minimally invasive procedure where a small hollow tube called a catheter is inserted into your femoral artery (located in the groin) and threaded to your carotid arteries. Once the catheter is in place, a balloon is inflated to widen the artery, and a small wire mesh coil called a stent is inserted to keep your artery from narrowing again. The stent stays in place as a support to keep the artery open, and the artery heals around the stent.