Carotid Artery Stenosis

What is Carotid Artery Stenosis?

The carotid arteries are a pair of blood vessels that bring blood to your head and brain. Plaque can build in these arteries, causing carotid artery disease, which increases the chance of a stroke.

At Yale Vascular Surgery, we offer the widest range of treatment and management options for carotid artery stenosis. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Carotid Artery Stenosis

Healthy carotid arteries are smooth and flexible, providing a clear pathway for oxygen-rich blood and nutrients to flow to the head and brain structures. 

Over time, plaque, which consists of cholesterol, calcium, fibrous tissue, and other debris, can build up on artery walls. When this buildup occurs, blood flow is restricted, and the arteries become stiff and narrow, a process called atherosclerosis. The plaques can gather at microscopic injury sites within the carotid artery, creating a blood clot.

Symptoms of Carotid Artery Stenosis

In its early stages, carotid artery disease often does not show any signs or symptoms. Many patients discover they have the disease after the brain has been deprived of blood, causing a stroke or TIA (transient ischemic attack). A TIA occurs when blood flow to a part of the brain stops for a brief period of time; the patient may have stroke-like symptoms for one to two hours. TIAs are believed to be a warning that a true stroke is likely.

Signs and symptoms of a stroke or TIA may include:
  • Sudden numbness or weakness in the face or limbs, often on only one side of the body
  • Trouble speaking and understanding

  • Sudden trouble seeing in one or both eyes

  • Dizziness or loss of balance

  • A sudden, severe headache with no known cause

Having one of the above symptoms does not mean that you have carotid artery disease or that you are having a stroke. This list should be used as a guideline only. It is important that if you are experiencing one or more of the above symptoms of a stroke or a TIA, seek emergency care immediately.

Risk Factors of Carotid Artery Stenosis

Carotid artery disease has almost no symptoms in its early stages, which is why it is important to understand if you have risk factors for the disease and how to manage your potential for developing a stroke. At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management.

Factors that stress your arteries and increase the risk of injury, buildup of plaques, and disease include: 
  • High blood pressure 
  • Smoking 
  • Age 
  • Abnormal blood-fat levels
  • Diabetes
  • Obesity
  • Heredity/Family history
  • Physical inactivity
It is important to understand that having one or more of the symptoms does not mean that you have carotid artery disease. The list should be used only as a guideline.

Diagnosing Carotid Artery Stenosis

If you think you have carotid artery stenosis, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent a stroke.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures: 

Arteriogram (also called an angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Duplex Ultrasound 
A duplex ultrasound assesses the blood flow and the structures of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used (Doppler and B-mode). The B-mode transducer (wand-like device) is used to create an image of the vessel while the Doppler probe within the transducer evaluates the blood flow within the vessel.

Treatment of Carotid Artery Stenosis

The goal in treating carotid artery disease is to prevent a stroke. The treatment approach used depends on how blocked the artery is. At Yale Vascular Surgery, our surgeons and specialists can help you with your carotid artery disease, from managing mild blockages to surgically treating advanced narrowing.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery. 

Mild to Moderate Blockage

When you have mild to moderate blockage of your arteries, the following are generally recommended to manage your disease:
  • Make lifestyle changes to reduce stress on the arteries and slow the progression of atherosclerosis. 
  • Manage chronic conditions, such as high blood pressure, high cholesterol, and diabetes. 
  • Use anticoagulant medications to reduce the chance of developing a blood clot. 

Severe Blockage

When you have severe blockage of your arteries, or if you have experienced a TIA or stroke, surgery is the best way to remove the blockage. The two most common procedures are a carotid endarterectomy and a carotid angioplasty and stent. 

Carotid Endarterectomy
A carotid endarterectomy is a procedure used to remove plaque buildup on the artery walls. This procedure may be done under local or general anesthesia. The surgeon opens the affected artery to remove the plaque buildup and then repairs the artery with a stitch or graft. 

Carotid Angioplasty and Stent
Depending on your overall health or where the blockage of the artery is located, a carotid angioplasty or stenting may be necessary. This procedure, done under local anesthesia, uses a tiny balloon threaded by a catheter. The catheter brings the balloon to the area of narrowing and is then inflated to widen the artery so that a small stent can be placed to keep the artery from narrowing again.