The carotid arteries are the two large blood vessels at each side of the neck. Carotid artery stenosis (narrowing) occurs when the carotid arteries become narrow or blocked by carotid artery disease.
The carotid arteries are the main supply of blood to the brain. The most common cause of blockage in these arteries is atherosclerosis, in which fatty materials collect under the inner lining of the arterial wall.
The risk of developing carotid artery stenosis increases with high blood pressure, high blood cholesterol levels, high stress levels, diabetes mellitus, diabetes, cigarette smoking, obesity, lack of exercise, and advanced age.
Most people with carotid artery stenosis have no symptoms, but if symptoms such as partial paralysis, blindness, or feelings of numbness are present, there is great risk of a major stroke. Carotid artery stenosis can also cause transient ischemic attacks (TIAs), also called "mini strokes." With a TIA, small pieces of the fatty materials in the arteries break away and lodge in the small blood vessels leading to the vein. This blocks the blood supply to the brain temporarily and results in symptoms such as blindness in one eye, numbness and tingling of the skin, and weakness of an arm or a leg. TIAs usually last anywhere from 2 to 30 minutes. These symptoms are temporary and reversible, but people who have TIAs are more likely to have a stroke.
Carotid artery disease is usually detected during a routine physical examination. Your doctor will be able to hear the blood rushing past the blockage in the carotid artery by listening with a stethoscope. An ultrasound test is used to create pictures of the blockage and to measure the amount of blood flowing through the artery. Another frequently used diagnostic test is called a cerebral arteriogram. A special dye is injected into an artery. An X-ray then shows the location and size of the blockage, which are revealed by the path the dye is able to take. If your doctor suspects a stroke, he or she may also order a computed tomography (CT) scan of your head to check brain function. It is important to tell your doctor if you have had any recent episodes of loss of vision or minor paralysis.
The treatment for carotid artery stenosis depends upon the degree of blockage and the presence of symptoms. If the carotid artery is less than 70% blocked and there are no symptoms, doctors usually recommend aspirin treatment. One aspirin per day will reduce the likelihood of a blood clot and decrease the chance of stroke. Treatment will include regular checkups with your doctor to see if your condition changes.
If the carotid artery is less than 70% blocked, but you have symptoms, the treatment depends upon the results of the cerebral arteriogram. If this test shows no other problems, patients are usually started on daily aspirin treatment. Again, treatment will include regular checkups for any changes in your condition. However, if the plaque looks rough and irregular, your doctor may recommend surgery to remove the plaque.
If the carotid artery is more than a 70% blocked and you have symptoms, the usual treatment is surgery. This procedure, called carotid endarterectomy, involves removing the plaque from the carotid artery. You are placed under general anesthesia and the surgeon makes a small cut (incision) in your neck to expose the artery. He or she then makes a cut in the artery and removes the blockage. The artery is repaired and the incision in your neck is closed with stitches. Following the surgery, you may need to take medicine that makes your blood less likely to clot. There is a 1-2% risk of stroke with this procedure. Another promising procedure is called carotid angioplasty. With this procedure, the area around the carotid artery is numbed with a local anesthetic. Then, a long, thin tube, called a catheter, is passed into the carotid artery in the area of the blockage. The catheter has a balloon on its tip. When the balloon is inflated, it stretches and opens the blocked artery.
You can help prevent carotid artery stenosis and stroke by following recommendations for preventing atherosclerosis. This means following a diet that is low in fat and cholesterol, exercising regularly, maintaining a healthy weight, and avoiding cigarette smoking.
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