Carotid Artery Disease

Carotid artery disease causes narrowing of neck arteries that supply blood to the brain. This blockage can lead to a stroke or transient ischemic attack. Early detection with ultrasound or angiography followed by treatment through surgery or stenting can prevent brain damage and improve long-term outcomes.

Carotid Artery Disease
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Understanding Carotid Artery Disease

Carotid artery disease is one of the leading causes of stroke and it occurs when the main arteries supplying blood to your brain become narrowed or blocked. This narrowing is typically due to the build-up of cholesterol and fat deposits known as plaques. The longer this process continues the more severe the blockage becomes. If left untreated it can lead to a life-threatening stroke.

Carotid arteries are large blood vessels located on either side of your neck. They carry oxygen-rich blood from the heart to the brain. Over time these arteries may accumulate plaque which hardens and narrows the vessels. This is called atherosclerosis. Reduced blood flow through these arteries can cause brain ischemia which means reduced oxygen supply to the brain. In severe cases it leads to a stroke.

In India awareness about carotid artery disease remains low and many patients come to medical attention only after suffering a stroke. With the right diagnosis and timely intervention strokes caused by carotid disease are preventable.

How Carotid Artery Disease Leads to Stroke?

A stroke occurs when blood supply to a part of the brain is interrupted or significantly reduced. When carotid arteries are blocked due to plaque buildup the blood flow to the brain is reduced. In many cases a piece of plaque breaks off and travels to smaller brain arteries where it causes a sudden blockage. This can result in either a transient ischemic attack (TIA) or a full-blown ischemic stroke.

A TIA is often called a mini-stroke and its symptoms resolve within 24 hours. However it serves as a strong warning sign that a major stroke may follow. Early evaluation and treatment can save lives.

It is estimated that up to 75 percent of all ischemic strokes originate in the neck due to carotid artery blockage. Recognizing symptoms and seeking early evaluation can drastically reduce stroke risk.

Who Is at Risk for Carotid Artery Disease?

Carotid artery disease shares risk factors with other vascular conditions. People at high risk include:

  • Individuals over 60 years of age
  • Smokers or those with a history of tobacco use
  • Diabetics
  • Patients with high blood pressure
  • Those with high cholesterol
  • Individuals with a family history of stroke or heart disease
  • People with sedentary lifestyles or poor dietary habits

You may not experience any symptoms in the early stages of carotid disease. That is why regular health checkups especially in high-risk individuals are essential.

Symptoms of Carotid Artery Disease

Carotid artery disease is often silent until it becomes severe. When symptoms do appear they may indicate a TIA or a stroke. Common symptoms include:

  • Sudden weakness or numbness in the face arm or leg often on one side
  • Sudden difficulty in speaking or understanding speech
  • Sudden loss of vision in one or both eyes
  • Dizziness or loss of balance
  • Sudden severe headache

If any of these symptoms appear medical help must be sought immediately. Timely treatment can reduce brain damage and improve survival.

How Is It Diagnosed?

Diagnosis of carotid artery disease is straightforward and non-invasive in most cases. Your doctor may perform the following:

This is a simple painless scan that uses sound waves to visualize the blood flow in your neck arteries. It helps detect narrowing or plaque buildup.

These are advanced imaging scans that give a detailed view of the arteries in the neck and brain. They help plan further treatment especially if surgery or stenting is being considered.

This is a minimally invasive test where a contrast dye is injected through a blood vessel and X-ray images are taken. It remains the gold standard in evaluating the anatomy of carotid arteries.

Treatment Options for Carotid Artery Disease

Treatment depends on the degree of blockage presence of symptoms and overall health condition of the patient. There are both surgical and minimally invasive methods available.

This is an open surgical procedure where the carotid artery is exposed and the plaque is physically removed from within the artery. The artery is then closed with the help of a vein or graft patch to make the vessel wider and prevent future narrowing. This technique is called patch plasty.

CEA is performed under general or local anesthesia and usually takes around 2 hours. It is one of the most effective and time-tested methods for preventing stroke in patients with severe carotid artery disease.

Benefits of Carotid Endarterectomy

  • Direct removal of the plaque
  • Lower chance of emboli (clots) going to the brain
  • Durable results with long-term patency
  • Highly effective in both symptomatic and asymptomatic high-grade stenosis

This procedure is generally recommended for patients with more than 70 percent blockage or those who have suffered a TIA or minor stroke.

In patients who are at high surgical risk or when anatomy favors a minimally invasive approach carotid artery stenting (CAS) is performed. This procedure is done through a small puncture in the groin and guided under X-ray.

A thin tube called a catheter is advanced into the carotid artery. Before crossing the plaque a filter device called an embolic protection device is placed beyond the blockage. This filter captures any debris that might dislodge during the procedure. Then a stent is deployed to hold the artery open and restore smooth blood flow.

Advantages of Carotid Stenting

  • Minimally invasive
  • No surgical incision in the neck
  • Shorter hospital stay
  • Faster recovery
  • Ideal for elderly and high-risk patients

The procedure is done under local anesthesia and patients are usually discharged within a day or two.

These are office-based procedures done under local anesthesia or sedation. The goal is to seal the faulty veins from inside, so blood flows through healthier veins.

Endovenous Laser Ablation (EVLA)

  • A thin fiber is inserted into the vein, and laser energy is used to seal it shut.
  • No cuts, stitches, or hospitalization required.
  • Quick recovery, minimal pain.

Radiofrequency Ablation (RFA)

  • Uses heat via radio waves to close off the vein.
  • Similar outcomes to laser, with low complication rates.

Endovenous Glue Therapy

  • A special medical glue is used to seal the vein.
  • No thermal energy or post-op stockings needed.
  • Ideal for needle-phobic or elderly patients.

Microwave Ablation

  • A newer modality that uses microwave energy.
  • Efficient in treating large-caliber veins with minimal heat spread.

Sclerotherapy

  • Suitable for smaller veins and cosmetic concerns (spider veins).
  • A medicine is injected into the vein, causing it to collapse and fade.
  • Performed alongside endovenous procedures.
  • Tiny incisions are made to hook out bulging veins.
  • Helps reduce symptoms and improves cosmetic appearance.
  • Removal of the entire saphenous vein via open surgery.
  • Rarely done today due to the success of endovenous techniques.
  • Reserved only for select cases where endovenous access isn’t possible.

Medical Therapy

For patients with mild to moderate stenosis medical therapy is crucial. It includes:

  • Blood thinners to reduce clot formation
  • Statins to control cholesterol levels
  • Blood pressure and sugar control
  • Lifestyle changes including quitting smoking a healthy diet regular exercise and weight control

Medical management is also essential after surgical or stenting procedures to ensure long-term success.

When Should You Seek Medical Help?

You should consult a vascular surgeon if:

  • You have a history of stroke or TIA
  • You experience sudden neurological symptoms like weakness or vision loss
  • Your doctor suspects carotid bruit (abnormal sound in the neck)
  • You are above 60 with risk factors like hypertension or diabetes

Early consultation and timely treatment can prevent irreversible damage to the brain.

A silent blockage today can become tomorrow’s stroke — early detection saves lives.

Prevent Stroke Before It Starts: Get Screened for Carotid Artery Disease

Carotid artery disease is a serious but preventable cause of stroke. The key lies in early detection timely intervention and appropriate lifestyle modification. Whether it is open surgery or stenting the goal remains the same — to ensure smooth uninterrupted blood flow to the brain and prevent devastating outcomes like stroke. If you or your loved one is at risk or has had a TIA or minor stroke do not wait. Book a consultation with a vascular specialist. A simple scan can change the course of life.