Carotid artery stenosis is the narrowing of the two large arteries on either side of the neck that carry oxygen-rich blood from the heart to the brain. Also called carotid stenosis, it is caused by the build-up of fatty deposits, calcium, cholesterol and other fibrous material (plaque) within the arteries – this is known as atherosclerosis. The stenosis can advance over time and completely block the artery, and this may lead to a stroke.

Carotid artery stenosis can increase the risk of stroke through the following ways:

• Plaque deposits can grow larger and narrow the artery severely thus causing reduced blood flow to the brain. Plaque can also cause complete blockage to the artery (occlude).
• Plaque deposits can deform the artery wall, cause blood clots to form and block the blood flow to the brain.
• Plaque deposits can rupture and break away from the large artery, travel downstream to lodge in a much smaller artery thus blocking the blood flow to the brain.

Causes of Carotid Artery Stenosis

Atherosclerosis (the build-up of plaque in the large arteries that deliver blood to the brain) is the major cause of carotid artery stenosis.

Normal arteries have smooth inner walls and are flexible but carotid arteries that are clogged with plaque tend to be narrow and stiff and have trouble delivering nutrients and oxygen to the brain.

Factors that can increase the risk of carotid artery stenosis include high blood pressure, diabetes, high cholesterol levels, tobacco use, age, family history, obesity, sleep apnea and lack of exercise.

Symptoms of Carotid Artery Stenosis

Carotid artery stenosis does not produce symptoms until a clot forms or the artery becomes severely narrowed. The first symptom to show is usually a mini stroke which is also known as transient ischemic attack (TIA). TIA occurs when the blood flow to the brain is interrupted temporarily and then restored. TIA lasts a couple of minutes and then resolves completely with the person returning to normal.

TIA should be taken seriously as it is a sign that a stroke or brain injury could be looming.

Symptoms of TIA or stroke include sudden:

• Trouble understanding and speaking
• Numbness or weakness in the limbs or face often happening on one side only
• Trouble seeing in both or one eye
• Dizziness
• Loss of balance
• Severe headache with no known cause

Diagnosis of Carotid Artery Stenosis

Carotid artery disease can sometimes cause a bruit or an abnormal sound in the artery and it can be heard by a stethoscope.

Imaging tests that can diagnose, localize and measure stenosis include:

• Carotid ultrasound: This uses sound waves to create real time photos or the arteries and locate blockages
• Computed tomography angiography (CTA): This test produces detailed views of the arteries
• Magnetic Resonance angiography: This is a non-invasive test similar to CTA but does not use ionizing radiation
• Cerebral angiography: This is also called intra-arterial digital subtraction angiography (IADSA). It is a minimally invasive test involving a catheter being guided through an artery to the targeted area. Contrast material is then injected through the tube and the images are captured with x-rays.

Treatment of Carotid Artery Stenosis

The main aim of treating carotid artery stenosis is to prevent stroke. Treatment usually depends on the extent of blockage in the carotid arteries.

For mild to moderate blockage, the physician might recommend medication to lower cholesterol or control blood pressure or lifestyle changes such as losing weight, quitting smoking, eating a healthy diet and regular exercise.

For severe blockage or if you’ve already had TIA, your physician might recommend removing the blockage from the artery through one of the following options:

• Carotid endarterectomy: This involves making an incision along the front of the neck with the surgeon opening the affected carotid artery and removing the plaques. The artery is then repaired with a graft or stitches.
• Carotid angioplasty and stenting: If carotid endarterectomy cannot be performed, a balloon is threaded by a catheter to the location of the clog in the artery, inflated to widen it, then a stent is inserted to prevent the artery from narrowing again.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service. From initial consultation through to final diagnosis, treatment and beyond. Our multidisciplinary team of expert doctors, nurses, cardiologists and technologists are here to offer tailored management and treatment of your condition, and to answer any questions that you may have throughout your time with us. Whatever you need us for, we’re only a phone-call away.