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Carotid Artery Narrowing and Stroke

When atherosclerosis builds up in the carotid artery, blood flow to the brain may be impaired, increasing your risk of stroke. A stroke is damaged brain tissue caused by a vascular problem. There are many potential warning signs for stroke. These warning signs are termed "transient ischemic attacks" (TIA) and include:
  • A sudden weakness or even paralysis of a leg, arm, or hand.
  • Transient slurring, garbled or inappropriate speech.
  • Transient blindness or severe blurring of vision in one eye.
  • A transient one-sided facial droop.

Other potential warning signs for stroke include blackout spells or severe headaches.


A TIA, or "mini-stroke," is a temporary condition is which the blood flow to a part of the brain is restricted, leading to transient neurological deficits. A stroke is when the blood supply to a part of the brain is completely blocked, leading to the death of brain cells and often death. Stroke is the third leading cause of death in United States-more than 150,000 deaths each year-and approximately 50 percent of all strokes are caused by buildup of plaque in the arteries.

A carotid occlusion does not always lead to a stroke. Sometimes other arteries will expand to transport the blood the brain needs if the carotid arteries are blocked. Also, the carotid arteries are big enough that a significant blockage still will allow enough blood to flow through. A serious blockage however, increases the risk that an embolus will form.


Often carotid occlusive disease is not diagnosed until a patient has a stroke, but imaging techniques have made it possible to catch an occlusion before that happens. Carotid stenosis is assessed first with a thorough physical examination. This examination can reveal specific neurological, motor, and sensory deficits that can provide clues about both the extent and location of an occlusion. In addition, physicians may be able to hear changes in blood flow in the carotid arteries with a stethoscope. A complete diagnostic workup also includes carotid Duplex ultrasound followed by magnetic resonance imaging (MRI) and computed tomography (CT) scans, which are noninvasive techniques. Complex cases may require an informal angiogram in which a catheter (rubber tube) is inserted into the vessels to project a dye that provides pictures of the blood vessels.

Risk Factors for Carotid Artery Occlusive Disease

The carotid arteries are paired arteries in the neck that serve as the major blood supply to the brain. The major risk factors for carotid artery occlusive disease include atherosclerosis or "hardening of the arteries" elsewhere in the body, a history of smoking, diabetes, and high cholesterol levels.

Treatment of Carotid Artery Occlusive Disease

There are two options for the management of carotid artery narrowing. Currently, most patients are recommended standard open surgical treatment of the carotid narrowing. This operation, called carotid endarterectomy, is performed through a small incision in the neck and involves a "shelling out" of the plaque from the diseased artery. This procedure removes the plaque from the inside of the artery wall and restores normal blood flow through artery to the brain. The operation is generally well tolerated and involves a one to two day hospital stay.

A new, minimally invasive treatment for carotid artery narrowing, which may be offered to patients on a selective basis, is balloon stent angioplasty of the narrowed vessel. This procedure does not require incision in the neck and can be performed through a catheter introduced through the groin artery. This procedure also involves a one day hospital stay. After either standard carotid endarterectomy or balloon stent angioplasty, patients are followed with serial duplex ultrasound studies to monitor the progress of their carotid arteries.

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