Carotid Artery Disease

Many people have no symptoms. In some people, a doctor can hear a sound in their neck called a bruit (pronounced "broo-EE"). This is a whooshing sound that happens when a carotid artery is narrowed.

For some people, a transient ischemic attack (TIA) or stroke is the first sign of the disease.

If you have any of these symptoms of a TIA or stroke, call 911 or other emergency services right away.

• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
• A sudden, severe headache that is different from past headaches.

Carotid artery disease is caused by a process called hardening of the arteries, or atherosclerosis. Plaque builds up inside the carotid arteries. Things that can lead to this buildup include:

• Smoking.
• High blood pressure.
• High cholesterol.
• Diabetes.
• A family history of hardening of the arteries.

An ultrasound test is used to diagnose carotid artery disease. This test uses sound waves to show how blood flows through your carotid arteries. You may have other tests such as a CT angiogram or a magnetic resonance angiogram (MRA) to check your carotid arteries.

Screening tests for carotid artery disease are not recommended for people who do not have signs or symptoms of carotid artery disease. If you have risk factors, signs, or symptoms of carotid artery disease, your doctor may recommend an ultrasound test to check for it.

Some companies sell ultrasound screening. But insurance doesn't pay for these tests because experts don't recommend them. And since your doctor didn't prescribe the tests, they aren't there to explain the results to you. It's a good idea to talk to your doctor before having one of these tests.

The goal of treatment is to lower your risk of a stroke. Treatment depends on whether you have symptoms and how narrow your arteries are. You probably will take medicine. You also will be encouraged to have a heart-healthy lifestyle. Some people also have a procedure to lower their risk.

Medicines

You may take aspirin or another medicine to prevent blood clots. You will likely also take medicine to lower cholesterol. You may also take medicine to help manage blood pressure.

Heart-healthy lifestyle

A heart-healthy lifestyle can help lower your risk of stroke.

• Don't smoke. Avoid secondhand smoke too.
• Eat heart-healthy foods.
• Be active. Ask your doctor what type of exercise is safe for you.
• Stay at a healthy weight. Lose weight if you need to.
• Manage other health problems, such as diabetes. If you think you may have a problem with alcohol or drug use, talk to your doctor.
• Get vaccinated against COVID-19, the flu, and pneumonia.

Regular ultrasounds

Your doctor may recommend regular ultrasounds. This is to see if the narrowing in your arteries is getting worse.

Surgery or stenting

Surgery in the arteries is called carotid endarterectomy. The doctor makes a cut in the neck and takes the plaque out of the artery.

Some people have a stent placed inside a carotid artery. A stent may be inserted during a catheter procedure. In this procedure, a doctor puts a thin tube, called a catheter, into a blood vessel in your groin or arm. The doctor threads the tube up to the carotid artery in the neck. The catheter is used to place the stent. In another type of procedure, a stent is placed in the artery through a cut in the neck.

Surgery and stenting may help lower your risk of a stroke. But they also have a risk of serious problems. You and your doctor can decide together if you want to have surgery or stenting.

Narrowing (stenosis) in a carotid artery increases your risk of stroke. If you have serious blockage in the carotid arteries, you may have a procedure to open the narrowed arteries. Options include:

Carotid endarterectomy.

The doctor removes plaque buildup in the carotid arteries.

Carotid artery stenting.

A stent may be inserted during a catheter procedure. In this procedure, a doctor threads a thin tube, called a catheter, through a blood vessel up to the carotid artery in the neck. The catheter is used to place the stent.

In another type of procedure, a stent is placed in the artery through a cut in the neck.

The benefits and risks of a procedure must be carefully weighed. The procedure itself may cause a stroke.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may take medicine to lower your blood pressure, to lower your cholesterol, or to prevent blood clots.
• If you take a blood thinner, such as aspirin, be sure to get instructions about how to take your medicine safely. Blood thinners can cause serious bleeding problems.
• Do not smoke. People who smoke have a higher chance of stroke than those who quit. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Eat heart-healthy foods. These foods include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. You limit things that are not so good for your heart, like sodium, alcohol, and sugar.
• Stay at a healthy weight. Lose weight if you need to.
• Be active. Ask your doctor what type and level of exercise is safe for you.
• Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.
• Manage other health problems such as diabetes, high blood pressure, and high cholesterol. If you think you may have a problem with alcohol or drug use, talk to your doctor.
• Avoid infections such as COVID-19, colds, and the flu. Get the flu vaccine every year. Get a pneumococcal vaccine. If you have had one before, ask your doctor whether you need another dose. Stay up to date on your COVID-19 vaccines.