Summary
Highlights
Carotid artery stenosis is the narrowing of the carotid arteries in the neck, primarily due to atherosclerosis (plaque buildup). This narrowing can lead to parts of the plaque breaking off and forming an embolus, potentially causing an embolic stroke.
Risk factors for carotid artery stenosis are similar to those for general atherosclerosis: age, male sex, smoking, hypertension, poor diet, reduced physical activity, and high cholesterol. Patients with this condition are also at high risk for coronary artery disease and myocardial infarction.
The severity of carotid artery stenosis is classified by the reduction in artery diameter: mild (less than 50%), moderate (50-69%), and severe (70% or more).
Carotid artery stenosis is often asymptomatic until a Transient Ischemic Attack (TIA) or stroke occurs. A carotid bruit (a 'whooshing' sound due to turbulent blood flow) may be heard on examination. Diagnosis usually begins with a carotid ultrasound scan, followed by a CT or MRI angiogram for more detailed assessment before surgical intervention.
Management includes conservative approaches such as a healthy diet, exercise, smoking cessation, and managing co-morbidities like hypertension and diabetes. Medical therapy involves anti-platelet medications (aspirin, clopidogrel, ticagrelor) and lipid-lowering medications (atorvastatin). Surgical interventions, considered for significant stenosis, include carotid endarterectomy (scraping out plaque) or angioplasty and stenting (widening the artery with a balloon and inserting a stent).
A key complication of endarterectomy is stroke (around 2% of cases). Nearby nerves can also be injured, leading to temporary or permanent issues, such as facial weakness (facial nerve), swallowing difficulties (glossopharyngeal nerve), a hoarse voice (recurrent laryngeal nerve), or unilateral tongue paralysis (hypoglossal nerve).