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Carotid Stenosis

Your carotid arteries are the main pipelines for carrying blood to your brain. You have one on each side of your neck. You can feel your pulse by pressing on your carotid artery just under your jawline.

Carotid stenosis — also called carotid artery disease — occurs when a fatty substance called plaque or atherosclerosis builds up inside an artery. The plaque buildup can narrow an artery, or block it completely. It can also cause a blood clot to form, which can lead to a stroke.

In the U.S., stroke is one of the leading causes of death. About 20 percent of all strokes result from carotid stenosis.

Risk Factors for Carotid Stenosis
Symptoms of Stroke and TIA
Diagnosing Carotid Stenosis
Lifestyle Changes to Stop Disease Progression
Treating Carotid Stenosis
Why Virginia Mason?

Risk Factors for Carotid Stenosis

People who have a family history of stroke are at higher risk for carotid stenosis. 

Other risk factors include:

  • Male gender
  • Advanced age
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Obesity
  • Tobacco use

The incidence of narrowed or blocked arteries also increases with age. Patients younger than 60 years old have less than 1 percent incidence of carotid stenosis whereas patients older than 80 have a 5 percent to 7.5 percent incidence of carotid stenosis.

Symptoms of Stroke and TIA

In its early stages, carotid stenosis typically causes no symptoms. The first symptom is usually a stroke or transient ischemic attack (TIA). TIAs typically do not cause lasting damage, but someone who has had a TIA is at risk for a major stroke.

Symptoms of stroke and TIA include:

  • Blurred vision or vision loss
  • Weakness in the face, arm or leg
  • Problems with speech and language

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Diagnosing Carotid Stenosis

Patients with symptoms for TIA or stroke should have their carotid arteries evaluated to determine if there is narrowing in these vessels.

Diagnostic tests include:

  • Carotid Ultrasounds — A non-invasive test that determines the speed that blood passes through the carotid arteries.
  • Magnetic Resonance Angiography or Computed Tomography Angiography — Non-invasive tests that create 2-D and 3-D images of the carotid arteries.
  • Carotid Angiography — This invasive test is the gold standard of vascular imaging. It requires placing a catheter in the carotid artery to take X-rays of the vessel while dye is injected.

Your primary care provider, neurologist or vascular surgeon will determine which test is most appropriate for you.

Lifestyle Changes to Stop Disease Progression

A heart-healthy lifestyle can stop carotid stenosis from getting worse, and help prevent stroke.

Many of the same health habits that are good for everyone are also good for helping stop carotid stenosis from getting worse and for preventing a stroke.

These include:

  • Maintaining a healthy weight
  • Managing stress
  • Getting regular physical exercise
  • Smoking cessation
  • Limiting your intake of alcohol
  • Strict management of high blood pressure and diabetes

A heart-healthy diet is vital for people with carotid stenosis. Your doctor may recommend a heart-healthy eating plan that includes:

  • Fat-free or low-fat dairy products, such as skim milk
  • Fish high in omega-3 fatty acids, such as salmon, tuna and trout, about twice a week
  • Fruits, such as apples, bananas, oranges, pears and prunes
  • Legumes, such as kidney beans, lentils, chickpeas, black-eyed peas and lima beans
  • Vegetables, such as broccoli, cabbage and carrots
  • Whole grains, such as oatmeal, brown rice and corn tortillas

When following a heart-healthy diet, you should avoid eating a lot of red meat, saturated and trans fats, foods high in sodium and sugary foods and beverages.

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Treating Carotid Stenosis

Treatment for carotid stenosis depends on if a patient is having symptoms, the severity of the disease, and the patient’s age and overall health.

Many people with carotid stenosis take medication to lower their cholesterol levels along with medications to prevent blood clots from forming — such as aspirin.

When carotid arteries become narrowed by 70 percent or if someone has had a stroke, opening the carotid artery is considered.

The team that opens carotid arteries at Virginia Mason comes from the departments of Vascular Surgery, Radiology and Neurosurgery. These professionals are highly skilled and experienced in performing procedures to restore normal blood flow to the brain.

Carotid artery angioplasty and stenting is the widening of a carotid artery and inserting a tube or stent to keep it open. This procedure involves placing a catheter in the femoral artery within the leg to gain access to the carotid arteries. Next a balloon is navigated into the artery and inflated to push plaque against the wall of the artery (i.e. angioplasty). A small mesh tube called a stent is then inserted to support the artery wall and keep it from becoming blocked again. This stent holds the plaque against the wall of the artery allowing more blood to flow through the carotid artery.

After the angioplasty and stenting, patients typically stay in the hospital overnight and go home the next day. Platelet drugs (usually aspirin and Plavix®) are usually taken for a month after the procedure.

Carotid endarterectomy is a surgical procedure under general anesthesia. During this procedure, surgeons make an incision in the neck to reach the blocked artery. Then an incision is made into the artery itself where the blockage is located. The plaque buildup is then removed. A patch is sewn into the artery restoring normal blood flow to the brain. Patients typically stay in the hospital overnight and are discharged the next day. They are then on a regimen of taking aspirin.

Carotid angioplasty, stenting and carotid endarterectomy offer complementary roles in the management of carotid stenosis. Virginia Mason’s stroke team discusses each case and determines which procedure is best for each patient.

Why Virginia Mason?

At Virginia Mason, we do everything possible to make sure you feel comfortable and supported. Our cerebrovascular surgeons, interventional specialists, radiologists, technicians, nursing staff and social workers are all highly experienced and experts in their fields.

Our facilities are well equipped for even the most complex procedures, and our patient rooms and waiting areas are designed to be calm and comfortable for you and your family. For more information about care for carotid stenosis, call (206) 223-7525.

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