16850 Carotid Artery Disease Carotid Stenting

Overview

Your carotid arteries are two large blood vessels on either side of your neck. They carry oxygen-rich blood up to your brain. Carotid artery disease means these arteries have become narrowed or stiff, usually because fatty deposits called plaque (a mix of cholesterol, fat, calcium and scar tissue) have built up inside the artery wall. This build-up is called atherosclerosis. When the artery narrows, less blood reaches the brain, and small pieces of plaque or blood clots can break off and travel to the brain, which can cause a stroke or a warning event called a TIA (transient ischaemic attack, sometimes called a 'mini-stroke'). Carotid stenting is a procedure to widen the narrowed artery. A thin, flexible tube with a tiny balloon and a small mesh tube (the stent) is guided into the artery, usually through a small cut in the groin or the arm. The balloon gently opens the narrowing and the stent stays in place to hold the artery open so blood can flow freely again.

Yes, it is fairly common. Narrowing of the carotid arteries is one of the leading causes of stroke, especially in people over 60. Many people have mild narrowing without knowing it, and it becomes more likely as we get older.

It mostly affects adults over the age of 60, and it is slightly more common in men than in women. The risk is higher in people who smoke, have high blood pressure, high cholesterol or diabetes, are overweight, are not very active, or have a family history of heart disease or stroke. It is very rare in children.

Symptoms

Common symptoms

• Often there are no symptoms at all, and the narrowing is found during a check-up or after a scan for another reason.
• Sudden weakness or numbness in the face, arm or leg, usually on one side of the body
• Sudden trouble speaking, slurring words, or difficulty finding words
• Sudden loss of vision or blurring in one eye, like a curtain coming down
• Sudden dizziness, loss of balance or difficulty walking
• Sudden confusion or trouble understanding what others are saying
• Sometimes a doctor hears an unusual sound called a bruit (a 'whooshing' noise) through a stethoscope on the neck, which can be the first clue

Symptoms in children

• Carotid artery disease from plaque build-up is very rare in children.
• Children can have problems with neck arteries for other reasons, such as injury, inflammation, or inherited conditions affecting blood vessels.
• Any child with sudden weakness, speech difficulty or vision change needs emergency medical help straight away.

Symptoms in older adults

• The same warning signs as above, but they are sometimes wrongly put down to 'just getting older' or a dizzy spell — this can delay important help.
• Temporary symptoms that pass within minutes or hours are especially important to report, because they can be a warning before a stroke.
• Some older adults have memory or balance problems linked to reduced blood flow, which should be checked by a doctor.
• If you care for an older person, note any sudden changes and get help quickly.

Causes

Main causes

• Atherosclerosis — a gradual build-up of fatty plaque inside the artery wall, which narrows the artery and makes it stiffer
• A blood clot forming on the roughened surface of the plaque and then breaking off towards the brain
• Less common causes include previous radiotherapy to the neck, inflammation of the blood vessels, a tear in the artery wall (dissection), and inherited conditions affecting blood vessels

Risk factors

• Smoking, including being around other people's smoke
• High blood pressure
• High cholesterol or other blood fats
• Type 2 diabetes or prediabetes
• Being overweight or carrying extra weight around the waist
• Not being physically active
• An unhealthy diet high in salt, saturated fat and processed foods
• Drinking too much alcohol
• Getting older — risk rises after about 60
• Being male
• A family history of stroke, heart attack or artery disease
• Poorly controlled sleep apnoea

When to see a doctor

See a doctor urgently if:

• Any sudden weakness, numbness, speech problem, vision change or drooping on one side — call your local emergency number
• A temporary symptom that has already passed (a possible TIA) — arrange an urgent same-day assessment
• New or worsening neck swelling, severe headache, bleeding at the catheter site or fever after a stenting procedure

Book a routine appointment if:

• Your doctor has heard a 'whooshing' sound (bruit) through a stethoscope on your neck
• You have a strong family history of stroke or heart disease and want to review your risk
• You have high blood pressure, diabetes or high cholesterol and want to check how well they are controlled
• You have been advised to have a carotid scan and want to talk it through
• You have questions about medicines, lifestyle changes or an upcoming procedure

Diagnosis

Your doctor will start by asking about your symptoms and your health history, and will examine you, including listening to your neck with a stethoscope. If they suspect narrowing, they will arrange an ultrasound scan of the neck arteries, which is the usual first test. Depending on the results, they may arrange further imaging and blood tests to check your overall risk.

Tests that may be done

• Carotid ultrasound (also called a Doppler scan) — a painless scan using sound waves that shows how narrow the artery is and how well blood flows
• CT angiography or MR angiography — detailed pictures of the arteries using a special scan, sometimes with a dye
• Blood tests to check cholesterol, blood sugar, kidney function and other markers
• Blood pressure measurements, often over several days
• An ECG (heart tracing) to check for an irregular heart rhythm that can also cause stroke
• An echocardiogram (heart ultrasound) in some cases

What to expect at your appointment

The ultrasound is the most common test and is quick and comfortable. You lie on a couch, some cool gel is put on your neck, and a small wand is moved gently over the skin. It usually takes about 20 to 30 minutes and you can go home straight afterwards. For CT or MR scans, you may be asked to avoid eating for a few hours beforehand, and you may need to remove metal items. Your care team will explain exactly what each test involves and when you will get the results.

Treatment

Treatment aims to lower your chance of a stroke. For most people this means a combination of lifestyle changes and medicines to control blood pressure, cholesterol and blood sugar. If the narrowing is significant and you have had symptoms, your care team may also recommend a procedure to open the artery — either surgery (carotid endarterectomy) or carotid stenting. The right choice depends on your age, your general health, the shape of your arteries and your own preferences.

Self-care at home

• Stop smoking — this is the single most powerful thing you can do for your arteries, and your doctor can offer support
• Take any prescribed medicines exactly as directed and do not stop them without advice
• Check your blood pressure at home if advised, and keep a simple record
• Eat a balanced diet with plenty of vegetables, fruit, wholegrains and healthy fats, and less salt and processed food
• Stay active within your limits — build up gradually and ask your team what is safe for you
• Keep to a healthy weight and limit alcohol
• Learn the warning signs of stroke and TIA so you can act quickly
• Go to your follow-up appointments and scans, even if you feel well

Medical treatments

Your care team will usually suggest medicines to lower your blood pressure, to lower your cholesterol and to make blood clots less likely. Some people also need medicines to control diabetes. These are prescribed individually, and your doctor will explain why each one is suggested, how to take it, and what side effects to watch for. Never start, stop or change a medicine without speaking to your doctor or pharmacist first. Your pharmacist is a good person to ask about how to take your medicines and how they might interact with other things you take.

When is surgery considered?

A procedure may be recommended if a scan shows a significant narrowing, especially if you have had a TIA or stroke symptom, and if the risks of the procedure are acceptable for you. Carotid stenting is done under local anaesthetic or light sedation. A thin tube is passed through a small cut in the groin or arm and guided up to the neck artery. A tiny balloon opens the narrowing and a small mesh tube (the stent) is left in place to keep the artery open. You usually stay in hospital for a short time and go home with advice about medicines, activity and warning signs to watch for. Carotid endarterectomy is an operation under general or local anaesthetic where the surgeon opens the artery and clears out the plaque. Your specialist team will explain the benefits and risks of each option so you can decide together.

Living with this condition

Most people with carotid artery disease carry on with normal daily life. Your main job day to day is to keep your risk factors under control: take your medicines, keep active, eat well, and go to your check-ups. If you have had a stent, you will usually be asked to take medicines to prevent clots and to avoid heavy lifting or straining for a short period afterwards. Ask your team when you can drive, fly, exercise or return to work.

Lifestyle tips

• Stop smoking and avoid smoky places — ask about local stop-smoking support
• Build regular gentle activity into your week, such as walking, swimming or cycling
• Choose a heart-healthy eating pattern and keep salt low
• Limit alcohol and avoid binge drinking
• Aim for a healthy weight, losing a little at a time if needed
• Get enough sleep and speak to your doctor if you snore heavily or feel very sleepy in the day
• Manage stress with things you enjoy, breathing exercises, or talking to someone
• Keep up with your vaccinations, as chest infections can be harder if you have blood vessel disease

Diet and exercise

Aim for a Mediterranean-style way of eating: vegetables, fruit, beans, nuts, wholegrains, fish, and olive or rapeseed oil, with less red and processed meat, less salt and fewer sugary drinks. For activity, the goal for most adults is about 150 minutes of moderate activity a week — enough to make you breathe a little faster but still able to talk — plus some gentle strength work. If you are new to exercise or have other health conditions, start slowly and ask your doctor or a physiotherapist what is right for you.

Mental health and emotional wellbeing

It is very common to feel anxious after a TIA, a stroke, or a diagnosis of narrowed neck arteries. You may worry about another event, feel low, or find it hard to concentrate. These feelings are normal and treatable. Talking to your doctor, a counsellor or a support group can help a lot. If you ever feel you might harm yourself, or you feel you cannot cope, please contact your local emergency number or a crisis support line in your country straight away — you deserve help right away.

Prevention

Largely, yes. Carotid artery disease is closely linked to the same risk factors as heart disease, and many of them can be changed. Not smoking, keeping blood pressure and cholesterol in a healthy range, staying active, eating well and controlling diabetes all make a real difference to the health of your arteries.

Vaccines

There is no vaccine for carotid artery disease. Staying up to date with recommended vaccinations, such as flu and pneumonia vaccines if your doctor advises them, helps you stay well overall and reduces the strain that infections can put on your body.

Screening programmes

There is no general screening programme for carotid artery disease in most countries, because scanning everyone would find many mild narrowings that do not need treatment and would cause unnecessary worry. Instead, a neck scan is usually offered if you have had a TIA or stroke symptom, or if your doctor hears an unusual sound in your neck. If you have several risk factors, talk to your doctor about your overall heart and stroke risk.

Complications

If left untreated

• A stroke, which can cause lasting weakness, speech problems, memory difficulties or disability
• Repeated TIAs (warning events), which are a sign that stroke risk is higher
• Reduced blood flow to the brain, which can affect thinking, balance and daily function over time
• Rarely, a stroke can be life-threatening
• If a stent is used, the artery can re-narrow over time, so follow-up scans matter

Long-term outlook

The outlook is encouraging. Many people with carotid artery disease never have a stroke, especially when the condition is found and treated. Modern medicines, lifestyle changes and, where needed, procedures like carotid stenting have made a real difference. Most people recover well from stenting and return to normal activities within a short time, and regular follow-up helps catch any problems early. Taking things one step at a time, with support from your care team, gives you the best chance of staying well.

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