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A carotid artery on each side of the neck supplies blood to the brain. Carotid artery disease occurs when a substance called plaque builds up in either or both arteries. The buildup can narrow the artery and reduce the blood flow to your brain. This can raise your chance of a stroke or transient ischemic attack (TIA).
The narrowing in an artery is called stenosis. The more narrow an artery becomes, the greater the risk of stroke or TIA.
This disease develops in the same way as coronary artery disease.
Plaque can build up in the arteries in your body over time. This buildup is often called "hardening" of the arteries. Plaque may form because:
Many people have no symptoms. For some people, a TIA or stroke is the first sign of the disease.
If you have any of these symptoms of a TIA or stroke, call 911 or other emergency services right away.
Stenosis may be found during a physical exam. Your doctor may listen to your neck for a sound called a bruit (pronounced "broo-EE"). This whooshing sound is often heard when a carotid artery is narrowed.
If your doctor thinks you may have stenosis, you will have a Doppler ultrasound. This test uses sound waves to show how blood flows through an artery or vein. You also may have a CT angiogram or a magnetic resonance angiogram (MRA).
Routine tests for carotid artery disease are not recommended for everyone. Experts recommend them only for people who have symptoms.1
Some companies sell ultrasound screening at shopping malls or other places. But insurance doesn't pay for these tests because they are not recommended by experts. Plus, your doctor isn't involved in prescribing the test. So he or she isn't there to explain the results to you. It's a good idea to talk to your doctor before having one of these tests.
The goal of treatment is to lower your risk of a TIA or a stroke. Treatment depends on whether you have symptoms and how much of your arteries are blocked. You probably will take medicine. You also will be encouraged to make healthy lifestyle changes. Some people have procedures to increase blood flow in the arteries.
Most people who have carotid artery disease—or are at risk for it—will take aspirin or another medicine to prevent blood clots. If you have high blood pressure or high cholesterol, you will take medicine for those problems.
A heart-healthy diet and regular exercise can help lower blood pressure and cholesterol. This can reduce your risk of stroke as well as heart disease.
If you have some stenosis—but you don't have symptoms—your doctor may want you to have routine ultrasounds. This is to see if the narrowing in your arteries is getting worse.
Surgery in the arteries is called carotid endarterectomy. The doctor makes a cut in the neck and takes the plaque out of the artery.
Some people have a procedure called stenting. A doctor threads a thin tube through an artery in the groin and up to the carotid artery in the neck. Then he or she uses a tiny balloon to enlarge the narrowed part of the artery and places a stent to keep the artery open.
Surgery and stenting have a risk of serious problems, such as stroke or heart attack. People who are at increased risk for problems from surgery or stenting include those who have severe heart disease or other serious health problems. You and your doctor can decide together if you should have a procedure.
U.S. Preventive Services Task Force (2007). Screening for carotid artery stenosis. Available online: http://www.ahrq.gov/clinic/uspstf/uspsacas.htm.
Other Works Consulted
Krishnaswamy A, et al. (2011). The nonsurgical approach to
carotid disease. In V Fuster et al., eds., Hurst's The Heart, 13th
ed., vol. 2, pp. 2315–2330. New York: McGraw-Hill.
November 15, 2013
E. Gregory Thompson, MD - Internal Medicine & Jeffrey J. Gilbertson, MD - Vascular Surgery
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