Carotid stenosis is a condition characterized by progressive narrowing of a segment of the carotid artery due to atherosclerosis. A healthy artery is flexible and has smooth walls. However, as you age, small injuries and hypertension may result in a build-up of plaque, a sticky substance made up of cholesterol, calcium, fat, and other fibrous materials. Gradually, plaque deposits and form a large mass, blocking the inside of your blood vessel. Atherosclerosis also causes the arteries to become hard and rigid, resulting in stenosis.
The carotid artery starts as a common carotid artery in the chest and travels through the neck to the head. It divides into external and internal branches near your larynx. The internal carotid supplies the brain, and the external carotid supplies your face and scalp. The most common location of atherosclerosis is near the bifurcation, where the common carotid artery divides into external and internal arteries.
Carotid stenosis narrows the artery and reduces blood flow to the brain, increasing the risk of stroke. A Doppler ultrasound helps your doctor understand the extent of blockage which can further be charecterised by CT/MR angiography. If it is more than 60% then treatment is needed.
Carotid Stenosis Symptoms
Most patients with carotid stenosis have no symptoms until the clot forms or the artery is significantly narrowed.
Symptoms are mainly associated with a mini-stroke, known as a transient ischemic attack (TIA), a condition where the blood flow to the brain is temporarily blocked and then restored.
Symptoms of TIA include:
- Numbness, weakness, or paralysis of the face, hands, or one side of the body
- Blindness in one or both eyes or double vision
- Slurred speech
- Loss of balance or vertigo
These symptoms may last for a few minutes and later resolves completely. If you have any of the mentioned symptoms, they should not be ignored. Consult a doctor immediately.
Carotid Stenosis Treatment
Patients with low-grade stenosis, typically less than 650%, are treated with medicines.
Some commonly used medicines include:
- Statins or cholesterol-lowering medicines
- Antiplatelet medicines such as aspirin and clopidogrel
- Antihypertensive medications such as ACE inhibitors and angiotensin blockers
It is usually recommended for patients with more than one TIAs or who have a moderate- or high-grade stenosis, above 60%.
Some common procedures include:
- Carotid angioplasty/stenting: It is a minimally invasive endovascular procedure performed during an angiogram. A flexible catheter is inserted through a small incision in the groin through the femoral artery to reach the carotid artery. A small catheter with a balloon is placed across the plaque. The balloon is inflated to compress the plaque and dilate the artery. After this, the balloon is deflated and removed. A stent is placed over the plaque, holding open the artery.
- Carotid endarterectomy: It is open surgery to remove the plaque.It requires a cut to be made in the neck, to open the artery and remove the plaque.