Carotid artery stenosis refers to the narrowing of the main arteries in the neck (carotid arteries) that supply blood to the brain.
This condition is usually caused by atherosclerosis — a buildup of fatty plaque on the vessel walls — which increases the risk of transient ischemic attack (TIA) or ischemic stroke.
Early detection and treatment are crucial to prevent permanent brain damage. Modern therapy combines medical management, endarterectomy, or stent placement, depending on the degree of narrowing and patient risk profile.
Symptoms
Carotid stenosis often progresses silently and may not cause symptoms until blood flow to the brain is significantly reduced or blocked.
When symptoms do appear, they are warning signs of an impending stroke.
Common warning signs (TIA or “mini-stroke”) include:
- Sudden weakness or numbness on one side of the body
- Difficulty speaking or understanding words
- Drooping of one side of the face
- Vision loss in one eye (amaurosis fugax)
- Dizziness, imbalance, or confusion
These symptoms usually last a few minutes to hours — but they are medical emergencies requiring immediate evaluation.
Diagnosis
Diagnosis begins with carotid Doppler ultrasound, a non-invasive test that measures blood flow and detects plaque buildup.
For surgical planning or confirmation, CT angiography (CTA) or magnetic resonance angiography (MRA) provides detailed imaging of the carotid and intracranial arteries.
In complex cases, digital subtraction angiography (DSA) gives the most precise anatomical information.
Blood pressure, cholesterol, and cardiac evaluation are also performed to assess systemic vascular risk.
Treatment Options
1. Medical Management
For mild to moderate stenosis, aggressive medical therapy can effectively prevent stroke:
- Antiplatelet medications (aspirin, clopidogrel)
- Statins to lower cholesterol
- Blood pressure and diabetes control
- Lifestyle modifications — quitting smoking, healthy diet, regular exercise
2. Carotid Endarterectomy (CEA)
The gold standard surgical treatment for significant (usually >70%) carotid narrowing.
Under microscope guidance, the surgeon opens the artery, removes the plaque, and restores normal blood flow.
This procedure significantly reduces the risk of future stroke when performed before major symptoms occur.
3. Carotid Artery Stenting (CAS)
A minimally invasive alternative for selected patients, especially those with high surgical risk or previous neck surgery/radiation.
A balloon and stent are placed via a catheter (usually from the groin or wrist) to widen the artery and trap plaque.
CAS offers shorter recovery time and is often performed under local anesthesia.
Recovery & Follow-Up
Most patients recover quickly after surgery or stenting — usually discharged within 24–48 hours.
Follow-up includes ultrasound surveillance every 6–12 months to monitor for restenosis.
Continued antiplatelet and statin therapy remains essential for long-term protection.
Rehabilitation may be required if the patient had a prior TIA or mild stroke.
When to See a Neurosurgeon
If you have sudden weakness, speech difficulty, or temporary vision loss, you may be experiencing a TIA — a serious warning of stroke.
Even if symptoms resolve, urgent medical attention can prevent irreversible damage.