Carotid stenosis and narrowing

Causes

The primary cause of carotid stenosis is atherosclerosis. Risk factors for the development of atherosclerosis and carotid stenosis include:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Physical inactivity
• Unhealthy diet
• Family history of atherosclerosis or cardiovascular disease
• Age (risk increases with age)
• Chronic kidney disease

Symptoms

In many cases, carotid stenosis does not cause noticeable symptoms until it severely restricts blood flow or leads to a stroke. Symptoms of a stroke or transient ischemic attack (TIA, often referred to as a “mini-stroke”) may include:

• Sudden weakness or numbness in the face, arms, or legs, especially on one side of the body
• Difficulty speaking or understanding speech
• Sudden vision problems in one or both eyes
• Dizziness or loss of balance
• Sudden, severe headache with no known cause
• Difficulty swallowing

Diagnosis

Carotid stenosis is diagnosed through various methods:

• Physical Exam: Listening for a bruit (a whooshing sound) over the carotid artery with a stethoscope, which may indicate abnormal blood flow.
• Carotid Ultrasound (Doppler Ultrasound): A non-invasive test that uses sound waves to create images of the carotid arteries and measure blood flow, identifying blockages or narrowing.
• Computed Tomography Angiography (CTA) or Magnetic Resonance Angiography (MRA): These imaging tests provide detailed images of the carotid arteries and can detect narrowing or blockages.
• Carotid Angiography: A more invasive test involving the injection of a contrast dye to visualize the carotid arteries in detail. This is often performed when a surgical intervention is being considered.

Treatment

Treatment for carotid stenosis focuses on reducing the risk of stroke and may include:

• Lifestyle Changes: Such as adopting a healthier diet, increasing physical activity, quitting smoking, and managing weight.
• Medications: To control blood pressure, lower cholesterol, and prevent blood clots.
• Surgical Procedures: For significant narrowing (usually 70% or more) or in cases where symptoms have already occurred, surgical options include:
  • Carotid Endarterectomy: Surgical removal of plaque from the carotid artery to restore normal blood flow.
  • Carotid Artery Angioplasty with Stenting: A less invasive procedure where a balloon is used to expand the narrowed artery, and a stent is placed to keep it open.