Dr. Tigran Khachatryan, MD, PhD.

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Carotid Artery Stenosis

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Your Guide to Understanding Carotid Artery Stenosis

This booklet will help you understand carotid artery narrowing, also known as carotid artery stenosis or carotid artery disease. This condition can increase your risk of a stroke, but there are ways to manage and treat it.

What is Carotid Artery Narrowing?

Your body has two large blood vessels, called carotid arteries, located on each side of your neck. These arteries are crucial because they carry oxygen-rich blood to your brain, face, and head. When these arteries are healthy, they are smooth and open, allowing blood to flow freely. Carotid artery narrowing occurs when a sticky substance called plaque builds up inside these arteries. Plaque is made up of fatty cholesterol deposits. This buildup causes the artery to narrow, making it harder for blood to reach your brain. This process is known as atherosclerosis or “hardening of the arteries.” If the blockage becomes severe, or if pieces of plaque break off, it can lead to a stroke, which is a serious medical emergency. You can develop this condition in one or both of your carotid arteries, and it can worsen over time without proper medical care.

Causes and Risk Factors

The main cause of carotid artery narrowing is atherosclerosis, which usually develops over many years. Several factors can increase your chance of developing this condition:
  • Smoking and using tobacco products
  • High blood pressure
  • High cholesterol, especially "bad" (LDL) cholesterol
  • Diabetes
  • Obesity or excess weight
  • Leading a sedentary lifestyle (not being physically active)
  • Age (the risk increases as you get older)
  • A family history of carotid artery disease or atherosclerosis
  • Existing heart disease
  • Sleep apnea (pauses in breathing during sleep)
  • Eating a diet high in fats and salt

Symptoms

In its early stages, carotid artery narrowing often doesn’t cause any symptoms. You might not realize you have the condition until it becomes serious enough to affect blood flow to your brain.

The first sign is often a Transient Ischemic Attack (TIA), also called a “mini-stroke.” This happens when blood flow to a small part of your brain is temporarily blocked and then quickly restored. TIA symptoms are temporary and usually resolve completely, but they are a crucial warning sign that a full stroke could be coming.

A stroke occurs when the blood supply to a portion of your brain is completely cut off, causing brain cells to die. If you experience any of the following symptoms, it is extremely important to seek emergency medical care immediately, even if they seem to go away quickly:

  • Sudden drooping of one side of your face
  • Sudden slurred speech or trouble finding words or understanding others
  • Sudden loss of vision in one eye, like a dark curtain coming down
  • Sudden numbness, weakness, or loss of movement on one side of your body (arm, leg, or face)
  • Sudden dizziness or loss of balance
  • A sudden, severe headache with no clear cause

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Complications

The most serious complication of carotid artery narrowing is a stroke. A stroke can lead to permanent brain damage, long-term disability, or even death. This can happen in a few ways:
  • The artery can become so narrow that not enough blood can reach your brain.
  • Pieces of plaque can break off and travel to smaller blood vessels in your brain, blocking them.
  • Blood clots can form on the rough surface of the plaque and block the artery or travel to the brain.

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Treatment Options

The main goal of treatment is to stop the disease from getting worse and prevent a stroke. Treatment options depend on how severe the narrowing is and whether you’ve had symptoms.

Medical Treatment

  • Lifestyle Changes: This includes eating a healthy diet, getting regular exercise, and stopping smoking. These habits are crucial for keeping your arteries healthy and preventing further plaque buildup.

Medications: Your doctor may prescribe medicines to:

  • Thin your blood and prevent clots, such as daily low-dose aspirin or other antiplatelet drugs.
  • Lower your cholesterol (statins) to help reduce plaque formation.
  • Control your blood pressure, as high blood pressure is a major risk factor for stroke.

Surgical Treatment Options

  • Carotid Endarterectomy: This is a traditional surgery where a surgeon makes a cut in your neck to directly remove the plaque from inside the carotid artery.
  • Carotid Artery Stenting (CAS): This is a less invasive procedure that uses a special tube called a stent to keep the artery open. This booklet will focus on carotid artery stenting.

Carotid Artery Stenting: What to Expect

Carotid artery stenting is a procedure designed to open a narrowed carotid artery, improve blood flow to your brain, and reduce your risk of stroke.

Before the Procedure (Presurgical Preparation)

  • Your doctor will provide specific instructions about your medications, especially if you take aspirin or other blood thinners. You may need to stop some medicines or adjust dosages.
  • It's important to drink plenty of fluids before the procedure to help your body flush out the special dye used during the process. If you have kidney, heart, or liver conditions, talk to your doctor about fluid intake.
  • You may undergo imaging tests like a CT scan or MRI beforehand to give your medical team detailed views of your carotid arteries and brain.

During the Procedure

  • A small, flexible tube called a catheter is usually inserted into a blood vessel in your groin (or sometimes your arm).
  • This catheter is carefully guided through your blood vessels up to the narrowed carotid artery in your neck.
  • Early studies show positive outcomes, with significant clinical improvement and resolution of symptoms like headaches in many patients.
  • After the balloon is deflated and removed, a mesh-like tube called a stent is placed in the artery. The stent expands and acts as a scaffold to hold the artery open, ensuring good blood flow.

After the Procedure (Postoperative Care)

Your recovery will vary, but here are general guidelines for caring for yourself at home:

  • Activity: You can do light activities around the house, like cooking. However, avoid strenuous exercise, heavy lifting, pulling, or pushing for at least 1 to 2 weeks, or until your doctor advises it's safe. If the catheter was in your groin, try to avoid stairs for a couple of days. If you received medicine to help you relax, avoid activities requiring focus (like driving or making important decisions) for 24 hours.
  • Catheter Site Care: You may have a bruise or small lump at the site where the catheter was inserted; this is normal and will fade. Keep a bandage over the site for about a day, or as your doctor recommends. You can usually shower after 24 hours, but pat the incision dry gently. Avoid creams, lotions, or ointments on the site until it's healed, and don't soak the area (like in a bath or pool).
  • Medications: It's crucial to take all your prescribed medicines exactly as directed, especially any blood thinners like aspirin. These are vital for reducing your risk of a stroke. Your doctor will tell you when to restart any medications you paused before the procedure.
  • Diet: Continue to eat a heart-healthy diet with plenty of fruits, vegetables, and whole grains. Drink enough fluids to help flush out the dye from your body.
  • Follow-Up: Regular follow-up appointments and tests are important to check blood flow in your carotid arteries and ensure they remain open.

Indications for Stenting

Your doctor might recommend carotid artery stenting if you have a significant narrowing (generally more than 70% blocked) in your carotid artery. It may also be considered if you have other health conditions that make traditional surgery (carotid endarterectomy) riskier, or if the narrowing has returned after a previous treatment, or if it was caused by prior radiation therapy.

Possible Complications and When to Call for Help

While carotid stenting is generally safe, as with any medical procedure, there are potential risks. Your medical team will discuss these with you. It’s vital to know when to seek help. Call 911 immediately if you experience:
  • Significant bleeding from the catheter site, or a fast-growing, painful lump there. (If this happens, lie down, apply firm pressure with your fingers or fist for 20 minutes, and keep pressure until emergency help arrives).
  • Symptoms of a heart attack, such as chest pain or pressure, sweating, shortness of breath, nausea, or sudden weakness.
  • Symptoms of a stroke, as listed in the "Symptoms" section above (e.g., sudden face drooping, trouble speaking, weakness on one side).
  • You passed out (lost consciousness).
  • Call your doctor or nurse advice line immediately if you notice:
  • Signs of infection at the catheter site, such as increased pain, swelling, warmth, redness, red streaks, pus, or a fever.
  • Your leg, arm, or hand (depending on where the catheter was inserted) is painful, looks blue, or feels cold, numb, or tingly.

Summary

Carotid artery narrowing is a condition where plaque builds up in the arteries supplying blood to your brain, increasing your stroke risk. It often has no early symptoms, making it crucial to know the warning signs of a TIA or stroke and seek immediate medical help if they occur. Treatment involves lifestyle changes, medications, and sometimes procedures like carotid artery stenting, which uses a small tube to keep the artery open. Following your doctor’s instructions for post-procedure care and maintaining a healthy lifestyle are key to a successful recovery and preventing future problems. Early detection and treatment can be lifesaving.

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