Your carotid arteries are the major blood vessels that deliver blood to your brain. One carotid artery is located on each side of your neck. When your doctor puts their hands on your neck to detect a pulse, they’re feeling one of your carotid arteries.
Carotid artery disease (CAD) occurs when a blockage in one or both of these arteries decreases the amount of blood flow to your brain. This can lead to a stroke.
According to the Centers for Disease Control and Prevention (CDC), more than 795,000 people have a stroke every year in the United States. Most of these strokes are either caused by CAD or atrial fibrillation, which is an irregular heartbeat. CAD causes more than half of all strokes in the United States.
CAD is typically caused by atherosclerosis, a disease in which plaque builds up in the arteries. A similar buildup occurs in the heart’s blood vessels when someone has coronary artery disease. Plaque contains clumps of:
- cellular waste
Atherosclerosis can make your carotid arteries narrower and less flexible over time, which limits the amount of blood flow to your organs.
CAD can also be the result of other diseases that cause arterial damage.
Some conditions can damage your arteries and put you at increased risk of CAD:
- High blood pressure can weaken your artery walls and make them more likely to become damaged.
- High cholesterol is a major risk factor for atherosclerosis.
- Diabetes can affect your body’s ability to process blood sugar. It increases your risk of high blood pressure and atherosclerosis.
- Obesity increases your risk of diabetes, high blood pressure, and atherosclerosis.
- Physical inactivity contributes to high blood pressure, diabetes, and obesity.
- Smoking can irritate the lining of your arteries. It can also increase your heart rate and blood pressure.
- Older age makes your arteries stiffer and more susceptible to damage.
- A family history of atherosclerosis is associated with increased CAD risk.
Early CAD rarely causes symptoms. Symptoms are only likely to appear once one of your carotid arteries has become fully blocked or nearly blocked. A carotid artery is usually considered nearly blocked when it’s more than 80 percent blocked.
At that point, you’re at high risk for a transient ischemic attack (TIA) or a stroke. A TIA is also known as a mini-stroke because it causes stroke symptoms that last from a few minutes to a few hours. These symptoms include:
- sudden weakness or numbness in the face, arms, or legs (usually on one side of the body)
- trouble speaking (garbled speech) or understanding
- sudden vision problems in one or both eyes
- sudden, severe headache
- numbness or weakness in your limbs
- numbness in one side of your face
- drooping on one side of your face
Call 911 or go to the emergency room immediately if you experience any of these symptoms. They could be signs of a medical emergency.
If you fall into a high-risk group for CAD, your doctor will want to test you for early signs of damage. During a physical exam, your doctor will listen to the arteries in your neck with a stethoscope for a swishing sound called a bruit. This is a sign that there’s a potential narrowing in your carotid vessels. Your doctor may also test your strength, memory, and speech.
There are additional tests that can be used to detect CAD.
This noninvasive test uses sound waves to measure the flow and pressure of blood in your vessels.
Computed Tomography Angiography (CTA or CT Angiography)
This is a way to take X-ray images of your vessels. A dye called contrast is placed in your vessels. The CT scanner then takes pictures from several angles.
Head CT Scan
This procedure takes pictures of your brain tissue to check for any bleeding or abnormalities.
Magnetic Resonance Angiography (MRA)
This test also uses contrast to highlight arteries in your neck and brain. Then, 3-D images are taken using a high-powered magnet.
This test takes detailed images of brain tissue without using contrast.
In this test, your doctor will insert a thin, flexible tube called a catheter into your carotid artery. Dye will be injected, and then an X-ray will be taken to view any abnormalities. This test is more invasive than the other forms of imaging. Therefore, it’s riskier.
A stroke is the main potential complication of CAD. A stroke occurs when the blood flow to the brain is interrupted. This can lead to loss of brain function or even death.
There are several ways that CAD can cause a stroke:
- Narrowed carotid arteries may not supply enough blood to the brain.
- A piece of plaque can break off and lodge in one of the smaller arteries of your brain, blocking blood flow.
- Blood clots can form in your carotid artery, blocking blood flow.
- Blood clots can break off from inside your carotid artery and block a smaller artery in your brain.
Your doctor will base your treatment plan on your symptoms and whether or not you’ve had a stroke.
If you’re diagnosed with CAD before you have a stroke, your doctor will suggest you make preventive lifestyle changes. These include:
- quitting smoking if you smoke
- exercising regularly
- eating healthy food
- managing any chronic conditions, such as heart disease and diabetes
- taking medications as prescribed
The treatment is more invasive if you’re diagnosed with CAD after having a stroke. Your doctor may need to open your carotid artery to remove the blockage. There are two different ways to do this.
Carotid endarterectomy is the most common form of surgery for severe CAD. After your anesthesiologist gives you local or general anesthesia, your doctor will make an incision on the front of your neck. Your doctor will open your carotid artery and remove any blockages. Your doctor will then stitch the artery closed. This is a relatively low-risk procedure that can have a lasting effect on preventing strokes.
Your doctor will use a carotid artery stent if the blockage is inconveniently located, you have a large blockage, or you have other serious health problems that make you a high-risk surgical candidate. A stent is a small wire coil. In this procedure, your doctor uses a balloon to widen a narrowed section of the artery. They then place a stent inside to keep the artery open.
Your long-term outlook will depend on the extent of your disease. However, there are things you can do to improve your health. These include:
- regularly checking your blood pressure
- testing your blood sugar and cholesterol levels one to two times per year
- taking a yearly carotid Doppler ultrasound test (if you’ve had a prior stroke), which is a short, painless test that allows your doctor to see the blood flow through your carotid arteries
- attending regular checkups with your doctor
There are steps you can take to decrease your chances of developing CAD:
- Quitting smoking can reduce your stroke risk to that of someone who doesn’t smoke within a few years.
- Limiting cholesterol and fat in your diet will reduce your risk of atherosclerosis.
- Getting regular exercise helps lower blood pressure, increase good cholesterol levels, and improve heart health.
- Reducing alcohol consumption may improve your heart health.
- Keeping a healthy weight can reduce your risk of developing CAD.
Managing diabetes and other chronic health conditions is also a great way to reduce your risk of long-term complications, such as CAD or stroke. Talk to your doctor about the best way to maintain the health of your heart and blood vessels.