Carotid Artery Disease

Diagnosis

Diagnosis of carotid artery disease begins with a detailed medical history and physical examination. During the exam, your healthcare professional listens for a swooshing sound, called a bruit, over the carotid artery in your neck. This sound can indicate narrowing of the artery. You may also undergo tests of strength, memory, and speech to check for any neurological effects.

Imaging Tests

To confirm the diagnosis and assess the severity of blockage, your doctor may recommend one or more of the following imaging tests:

• Ultrasound: This test evaluates blood flow and pressure in the carotid arteries, helping detect narrowing or blockages.

• CT and MRI scans: These imaging tests can reveal if you’ve experienced a stroke or other brain-related issues.

• CT angiography or MR angiography: These tests use contrast dye to create detailed images of the neck and brain arteries, helping identify the extent of blockage and plaque buildup.

If the cause of your symptoms remains unclear after these tests, a more detailed procedure called catheter cerebral angiography may be performed. In this test, a thin catheter is inserted into an artery in the groin or wrist and guided to the brain. A special dye is injected to make the blood vessels visible under X-ray imaging. This procedure helps pinpoint the exact location and type of plaque causing the blockage.

Treatment

The main goal of treating carotid artery disease is to prevent stroke by improving blood flow to the brain. Treatment depends on the severity of the blockage, the presence of symptoms, and your overall health.

Lifestyle and Medication Management

For mild to moderate blockages, non-surgical treatments are often recommended, such as:

• Quitting smoking and maintaining a healthy weight

• Eating a balanced diet low in saturated fats and sodium

• Exercising regularly to improve cardiovascular health

• Taking prescribed medications to manage blood pressure and cholesterol levels

• Using blood-thinning medicines such as aspirin to reduce the risk of blood clots

Surgical and Interventional Treatments

For severe carotid artery blockages or those causing symptoms such as a transient ischemic attack (TIA) or stroke, surgery or interventional procedures may be required.

• Carotid endarterectomy: In this common surgical procedure, the surgeon makes an incision in the neck, opens the blocked carotid artery, and removes the plaque buildup. The artery is then repaired with stitches or a graft to restore proper blood flow.

• Carotid angioplasty and stenting: For patients who are not good candidates for surgery, this minimally invasive procedure may be performed. A catheter with a small balloon is inserted into the blocked artery and inflated to widen it. A small mesh coil called a stent is then placed to keep the artery open and prevent future narrowing.