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Patient education: Carotid artery disease (The Basics)
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Patient education: Carotid artery disease (The Basics)
Written by the doctors and editors at UpToDate
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Nov 2017. | This topic last updated: Jul 28, 2017.

What is carotid artery disease? — Carotid artery disease is a condition that can increase a person's risk of having a stroke. The condition does not usually cause symptoms. It happens when fatty deposits called plaque buildup inside 2 blood vessels called the "carotid arteries." These are the main blood vessels that bring blood to the brain. When plaque forms in these arteries, the arteries can become narrow (figure 1).

What are the symptoms of carotid artery disease? — Carotid artery disease can cause strokes and TIAs (described below), though it does not always cause symptoms.

Strokes – A stroke is when a part of the brain is damaged because of a problem with blood flow. Carotid artery disease can lead to strokes, because blood clots can form inside the narrowed artery. Then the clots and other material from the fatty plaque can travel to the brain and clog smaller arteries.

Some people recover from strokes without lasting effects or with only minor problems. But many people have serious problems after a stroke. After a stroke, some people are:

Unable to speak or understand speech

Paralyzed on one half of their body

Unable to dress, feed, or take care of themselves

TIAs – TIA stands for "transient ischemic attack." TIAs are basically strokes that last only a short time. But they do not cause brain damage. TIAs happen when a blood vessel in the brain gets clogged briefly and then reopens. People who have TIAs can have the symptoms of a stroke, but the symptoms go away in a short time. People who have TIAs are at very high risk of having a full-blown stroke.

Is there a test for carotid artery disease? — Yes. Doctors can listen to each carotid artery with a stethoscope. They do this to check for a swishing sound that occurs when the artery is partly blocked. But to be sure, doctors also can use one of the following tests, which create pictures of the arteries:

Carotid duplex ultrasound – This test uses sound waves to create pictures.

Magnetic resonance angiography (MRA) – This test uses a magnet to create pictures. It works the same way that MRI tests work. Before having MRA, most people get an injection of a dye that makes the arteries show up more clearly.

Computed tomography angiography (CTA) – This test uses a special kind of X-ray called a CT scan. Before having the scan, people get an injection of a dye that makes the arteries show up more clearly.

There is another test that doctors sometimes use, called a "cerebral angiogram." But that is not usually necessary.

How is carotid artery disease treated? — Treatments for carotid artery disease focus mostly on preventing stroke. Treatments can include:

Lifestyle changes – People can reduce their risk of stroke by:

Quitting smoking if they smoke

Being active

Losing weight if they are overweight

Eating a diet low in fat and cholesterol and high in fruits, vegetables, and low-fat dairy foods

Medicines – Different people need different medicines to reduce their chances of having a stroke. In general, the medicines that can help prevent strokes include:

Medicines to lower blood pressure

Medicines called statins, which lower cholesterol

Medicines to prevent blood clots, such as aspirin

Surgery – Doctors can do surgery to remove plaque from the carotid arteries (figure 2). This is called "carotid endarterectomy." This treatment is most appropriate for people who have had a TIA or stroke caused by plaque in one of their carotid arteries.

Carotid stenting – Carotid stenting is when doctors insert a tiny metal tube called a "stent" into the carotid artery. The stent is designed to prop open narrowed arteries. This treatment seems to be more risky than surgery for people age 70 or older.

Which treatment is right for me? — The right treatment for you will depend on:

Whether you have already had a stroke or TIA caused by carotid artery disease

How much of your carotid artery is blocked off by plaque

How old you are

Whether you are a man or a woman

Whether you have other health problems besides carotid artery disease

If your doctor suggests surgery or stenting, ask these questions:

What are the chances that I will have a stroke in the next 5 years if I do not have this procedure?

What are the chances that I will have a stroke in the next 5 years if I do have this procedure?

What are the risks of the procedure?

Does the doctor who will do the procedure have a lot of experience?

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