Carotid Stenosis is the build up of plaque or atherosclerosis in the carotid (neck) arteries. Atherosclerosis (hardening of the arteries) is a condition where fatty deposits occur in the inner lining of the arteries, and atherosclerotic plaque (a mass consisting of fatty deposits) develops. The plaque may block (occlude) the artery, or a blood clot may occur at the site of the plaque build up or blockage and can lead to a stroke. A stroke occurs when a blood vessel bringing oxygen and nutrients to the brain bursts or is clogged by a blood clot or some other particle. Because of this rupture or blockage, part of the brain doesn’t get the blood flow it needs. Deprived of oxygen, nerve cells in the affected area of the brain can’t function and die within minutes. And when nerve cells can’t function, the part of the body controlled by these cells can’t function either. The devastating effects of a stroke are often permanent because dead brain cells aren’t replaced. Atherosclerotic plaque does not necessarily cause strokes. The blockage of the artery usually develops slowly. There are many small blood vessels around the carotid arteries. If blood flow gradually decreases, these small connections will increase in size and “by-pass” the obstructed area (collateral circulation). If there is enough collateral circulation, even a totally blocked artery many not cause neurologic deficits or a stroke. A second safety mechanism is that the arteries are large enough that 70 to 75% of the blood vessel can be occluded, and there may still be adequate blood flow to the brain.

Are there ways to prevent Carotid Stenosis?
Prevention includes control of risk factors. Hypertension, diabetes and heart disease and other risk factors should be treated as appropriate. Smoking should be minimized or, preferably, stopped.

What are the symptoms of Carotid Stenosis?
Symptoms of carotid stenosis are:

• Weakness or total inability to move a body part
• Numbness or loss of sensation
• Tingling or abnormal sensations
• Decreased or loss of vision (may be partial or temporary)
• Language difficulties (inability to speak clearly)
• Loss of memory
• Vertigo or dizziness
• Loss of coordination
• Difficulty swallowing
• Personality changes
• Mood and emotion changes
• Lack of consciousness

What are the signs and tests to diagnose Carotid Stenosis?

An examination may include neurologic, motor, and sensory examination to determine the specific neurologic deficits present, because they often correspond closely to the location of the injury to the brain. The examination may show emboli, in the retina, changes in reflexes including abnormal reflexes or abnormal extent of “normal” reflexes, muscle weakness, decreased sensation, and other changes. A bruit (an abnormal sound heard with the stethoscope) may be heard over the carotid arteries of the neck.

Additional tests may include:

• Carotid or cerebral angiography
• Carotid Duplex/Doppler Ultrasound

What is the treatment for Carotid Stenosis?
Carotid endarterectomy (CEA) is indicated as the treatment of choice for stroke prevention in patients that have carotid artery stenosis and that have low surgical risk. CEA is a surgical procedure in which atherosclerotic plaque is removed from the diseased carotid artery.

Carotid balloon angioplasty with stenting is currently being used for patients that are high surgical risks or patients that have underlying medical conditions that would put them at a higher risk for complications with a surgical procedure. Research studies are underway to test carotid artery stents and embolic protection devices, which catch debris breaking off from the diseased plaque during the balloon angioplasty procedure and therefore could possibly reduce the risks of stroke in these patients.