Carotid Artery Disease

Carotid artery disease occurs when blood flow is restricted due to narrowed and/or blocked carotid arteries. Individuals who have atherosclerosis are more likely to develop carotid artery disease.

Risk factors of carotid artery disease include:

• Advanced age
• Smoking
• Diabetes
• Obesity
• High-fat diet
• Family history and genetic factors
• High blood pressure (hypertension)
• Elevated fats in the blood (high triglycerides or cholesterol)

If you have risk factors of carotid artery disease or diagnosed atherosclerosis, your doctor may use the following tests to determine whether blocked carotid arteries are present:

• Duplex or doppler ultrasound – uses sound waves to measure how fast your blood is flowing to identify arteries that are narrowed or blocked
• Transcranial doppler – uses sound wave to measure blood flow in the brain to identify irregularities that may suggest blocked or narrow arteries
• CT scan – images the brain tissue and is often used to rule out bleeding or other problems
• CT angiogram – combines an injectable contrast dye and a CT scan of the head and neck to look for narrowing or blockages in carotid arteries
• Magnetic resonance imaging (MRI) – uses magnetic and radio waves to create images of brain tissue to look for signs of an early stroke or other problems
• MR angiography – combines an injectable contrast and MRI to create cross-sectional and 3D images of the carotid arteries
• Cerebral angiogram – catheter-based procedure used to help visualize the carotid arteries, creating detailed X-rays

If your carotid arteries are only mildly or moderately blocked, your doctor will recommend heart healthy lifestyle changes and may prescribe medications to control your blood sugar, lower your blood pressure and/or cholesterol. To reduce the risk of blood clots, antiplatelet medication may also be prescribed.

If your carotid artery blockage is severe, your doctor may use one of the following procedures:

• Carotid endarterectomy – through a small incision in your neck, the affected artery is opened, the plaque causing the blockage is removed and the artery is repaired
• Carotid balloon angioplasty and stenting – a minimally invasive procedure that uses a catheter-mounted balloon to flatten plaque causing a blockage. A stent is often placed to help keep the artery open. This is usually done through a groin access or through a newer transcarotid artery approach.
• Transcarotid arterial revascularization (TCAR) – a minimally invasive, hybrid procedure that places a carotid stent via the neck rather than the groin. The smaller incision used can lead to faster recovery times. Blood flow is also temporarily reversed during the procedure, which helps reduce a person's risk of stroke in the future.