16845 Carotid Artery Disease Carotid Artery Stenosis

Overview

Carotid artery disease happens when the main arteries in your neck that carry blood to your brain become narrowed by fatty deposits. This narrowing is called carotid artery stenosis. Over time, it can reduce blood flow to the brain and increase the risk of stroke.

Carotid artery disease becomes more common as people get older. It is a major cause of stroke, which is a leading cause of disability worldwide.

It mainly affects adults over 50, and men more often than women. People with high blood pressure, diabetes, high cholesterol, or a history of smoking are at higher risk. It also tends to run in families.

Symptoms

Common symptoms

• Often there are no symptoms until the narrowing is severe.
• A brief episode of weakness or numbness on one side of the body.
• Difficulty speaking or understanding speech.
• Sudden vision loss in one eye.
• Dizziness or loss of balance.

Symptoms in children

• Carotid artery stenosis is extremely rare in children. If it happens, it is usually linked to another condition such as inflammation of the blood vessels or an injury, and it needs urgent assessment.

Symptoms in older adults

• Older adults may notice sudden confusion, weakness, or a 'mini-stroke' that fully goes away. These symptoms are often brief but must never be ignored.

Causes

Main causes

• Atherosclerosis — the buildup of fatty plaque inside the carotid arteries
• Damage to the inner lining of the arteries over time, often from high blood pressure or smoking
• A blood clot or plaque fragment that narrows or blocks the carotid artery

Risk factors

• High blood pressure
• Smoking
• Diabetes
• High cholesterol
• Family history of stroke or heart disease
• Age over 50
• Being overweight or not getting enough physical activity

When to see a doctor

See a doctor urgently if:

• Sudden or passing symptoms of stroke or TIA — call your local emergency number immediately
• Unexplained loss of vision or difficulty speaking
• Sudden weakness on one side of the body

Book a routine appointment if:

• If you have risk factors and have never discussed stroke prevention with your doctor
• If you are due for a routine check-up and want to know your heart and stroke risk
• If you have been experiencing dizziness, fainting spells, or a whooshing sound in your neck

Diagnosis

A doctor will ask about your medical history, check your blood pressure and pulse, and listen over your neck with a stethoscope for an abnormal whooshing sound. If they suspect carotid artery disease, they will arrange imaging tests to look at the blood flow in your neck arteries.

Tests that may be done

• Carotid ultrasound — a painless scan using sound waves to see blood flow
• Doppler ultrasound — measures the speed of blood flow through the arteries
• CT angiography or MR angiography — detailed pictures of the blood vessels, sometimes using an injected dye

What to expect at your appointment

The tests are usually quick and painless. You may be asked to lie still while a gel is applied to your neck, or to have an injection of contrast for a scan. Your doctor will explain the results and discuss next steps with you.

Treatment

Treatment aims to prevent strokes and slow or stop plaque buildup. This usually involves a combination of lifestyle changes, medicines, and, in some cases, a procedure to reopen a narrowed artery.

Self-care at home

• Stop smoking and avoid second-hand smoke
• Keep blood pressure, blood sugar, and cholesterol in a healthy range
• Take all prescribed medicines exactly as directed
• Manage stress and seek support when needed
• Attend follow-up appointments and stroke prevention checks

Medical treatments

Doctors commonly use medicines to control blood pressure, lower cholesterol, and reduce the risk of blood clots. Antiplatelet medicines help stop platelets from sticking together and forming clots. Your doctor will choose the right treatment for you based on your age, other health conditions, and how severe the narrowing is. Always take medicines as prescribed and ask your doctor or pharmacist any questions you have.

When is surgery considered?

If the artery is very narrowed and symptoms have occurred, a specialist may recommend surgery to remove the plaque, called a carotid endarterectomy. Another option is a small tube called a stent, which can be placed to widen the artery. These decisions are made with a vascular or stroke specialist after a careful risk assessment.

Living with this condition

Your main job is to protect your brain and heart. This means taking your medicines daily, keeping blood pressure and cholesterol in a healthy range, and learning how to recognise stroke symptoms. It can help to keep a list of your medicines and the emergency number somewhere visible.

Lifestyle tips

• Eat a heart-healthy diet rich in fruits, vegetables, and whole grains
• Aim for regular physical activity, such as walking, after checking with your doctor
• Maintain a healthy weight
• Avoid smoking and limit alcohol
• Keep diabetes and blood pressure well managed

Diet and exercise

Try to eat more vegetables, fruits, oats, beans, fish, and nuts, and reduce salty, fried, and processed foods. Exercise does not need to be extreme — gentle walking for 20 to 30 minutes most days can help. Your doctor or a dietitian can help you make a plan that fits your routine.

Mental health and emotional wellbeing

Living with carotid artery disease can cause worry about having a stroke, and that anxiety is normal. Talk to your doctor if you feel low, anxious, or overwhelmed, and seek support from family and friends. If you ever have thoughts of harming yourself, contact your local crisis support service or your local emergency number right away.

Prevention

Yes, you can reduce your risk by controlling high blood pressure, not smoking, treating diabetes and high cholesterol, eating well, and staying active. These steps also slow plaque buildup in people who already have carotid artery disease.

Vaccines

Keep your vaccinations up to date, including flu and pneumonia vaccines, because infections can put extra strain on your heart and blood vessels. Ask your doctor which vaccines are recommended for you.

Screening programmes

Your doctor may check your blood pressure, cholesterol, and blood sugar at routine visits. A carotid ultrasound is not routine for everyone, but your doctor may advise it if you have had a stroke or TIA, or if they hear an abnormal sound over one of your carotid arteries.

Complications

If left untreated

• Stroke or transient ischaemic attack (TIA)
• Permanent brain damage or disability from a stroke
• Sudden blockage of the carotid artery causing a severe stroke

Long-term outlook

Carotid artery disease can often be managed effectively. Early detection and treatment greatly reduce the risk of stroke. Many people continue to live active, full lives by taking their medicines and making healthy changes one step at a time.

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