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Carotid Artery Disease

Last updated March 23, 2018

Approved by: Maulik P. Purohit MD, MPH

Blausen.com staff. "Blausen gallery 2014

Carotid Artery Disease is the narrowing of the blood vessels in the neck that carry blood from the heart to the brain.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Carotid Arterial Disease
  • Carotid Atherosclerosis
  • Carotid Atherosclerotic Disease

What is Carotid Artery Disease? (Definition/Background Information)

  • Blood pumped from the heart travels through the carotid arteries (located both sides of the neck), to reach parts of the brain, face, and head
  • In a Carotid Artery Disease, sometimes due to various lifestyle and/or genetic factors, the carotids become clogged with wax-like substances composed of fat, called plaque. This can potentially obstruct the free flow of blood causing a stroke, which may further lead to permanent damage of the brain
  • The disease develops slowly over time, usually with an advancing age. It requires both active and passive treatment measures to manage the condition, which include surgery, medications, and modifications to one's lifestyle

Who gets Carotid Artery Disease? (Age and Sex Distribution)

  • The incidences of Carotid Artery Disease, increases with age
  • Gender preference seems to shift with advancing age. Women over 75 years of age, are more prone to the disorder than men; but, if the age is below 75 years, men have a higher risk
  • No racial or ethnic preference is observed

What are the Risk Factors for Carotid Artery Disease? (Predisposing Factors)

Some of the potential risk factors for Carotid Artery Disease are the following. Most times, multiple risk factors are observed in an individual, which tend to create a greater impact:

  • A diet, high in fat, cholesterol, sugar, and salt, can cause unhealthy body conditions resulting in obesity, high fat (triglyceride) levels, low ‘good’ cholesterol (HDL) and high ‘bad’ cholesterol (LDL) levels
  • High blood pressure(hypertension)
  • Advancing age
  • Diabetes (this can increase the risk by almost 4-times) and high sugar levels. Type 2 diabetes, occurs due to the body’s inability to use insulin effectively (termed as insulin-resistance)
  • Smoking tobacco: It contributes significantly to the risk factors by creating a cholesterol level imbalance, limiting oxygen supply, and constricting/injuring blood vessels. This also causes elevated blood pressure levels
  • Leading a sedentary life; and a lack of physical activities (or a lack of exercise)
  • Certain diseases and disorders may cause narrow carotids and these include, connective tissue disorders (like Marfan syndrome), and fibromuscular dysplasia. This narrowing slows blood flow to the brain
  • A family medical history of stroke, atherosclerosis, coronary heart disease, increases the risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Carotid Artery Disease? (Etiology)

  • The carotid artery, like every other artery, is smooth and resilient permitting easy passage of blood. However, with time they become rigid and constricted, due to plaque deposits along the walls. This results in a condition known as atherosclerosis
  • Atherosclerosis causes blockage of the blood flow, restricting blood from reaching vital organs in the head. In severe cases it can even result in a stroke. This is the cause of Carotid Artery Disease, which occurs due to genetic- or lifestyle-related plaque buildup in the arteries
  • The plaque consists of microscopic fat particles, cholesterol, calcium, and cell debris. Tiny amounts of blood that accumulates at these deposits, harden, and clot. There is a possibility sometimes, that these blood clots might be carried by the blood to the brain. This can also lead to a stroke (called embolism-stroke), or cause other potential complications
  • There are many factors that aid in plaque formation and they include: Food, sedentary life, alcohol consumption, smoking tobacco, old age, familial factors, diabetes, and other disorders

What are the Signs and Symptoms of Carotid Artery Disease?

  • Mild Carotid Artery Disease can exist without any sign or symptom, for a long period of time. Rarely, even in  mild cases, there is a possibility that it might suddenly develop into a life-threatening situation
  • Stroke is the most frequent indication of carotid arterial blockage. Yet, this is many a times peceded by a condition, known as transient ischemic attack (TIA). TIA is a brief stoppage of blood flow to the brain
  • A TIA (normally observed for a couple of hours) serves as an early warning sign and key indicator of a possible ‘future’ stroke (that is, in the near future, or far future); which is a far more dangerous condition

Signs and symptoms of TIA (observed for a short while only) and/or stroke includes:

  • Vision problems; either blurred, or loss of vision
  • Memory loss, speech/language problems, incoherence
  • Unexplained and sudden numbness/weakness in one part of the body, loss of sensation
  • Confusion, loss of balance, dizziness
  • An intense and sudden headache

How is Carotid Artery Disease Diagnosed?

Diagnostic tests for Carotid Artery Disease include:

  • Physical exam with evaluation of medical history (for heart-related conditions too)
  • Listening to the carotid artery (in the neck) using a stethoscope, to detect any unusual ‘whooshing’ sounds
  • Blood test to determine blood sugar, cholesterol, triglyceride (a type of fat) levels
  • Evaluation of basic neurological status by performing tests that estimate the normal intellectual, physical, and mental abilities, of the individual
  • Testing blood flow, pressure values, and if any obstruction is present in the artery, using a doppler ultrasound (or sonography) scan
  • Carotid angiography: A technique, where a special dye is injected into the veins, to study them on x-ray images
  • Other imaging studies used include: CT angiography, MR angiography
  • A differential diagnosis should be considered to eliminate other related abnormalities

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Carotid Artery Disease?

Complications due to Carotid Artery Disease include:

  • Infrequently blood clots may develop, or bits of plaque may become dislodged from the arterial wall. These may obstruct blood flow, or travel to other vital organs like the brain, lungs, and heart
  • Stroke; having a potential to cause irreversible brain damage and paralyze the body (or parts of the body)
  • Coronary heart disease or other artery-related disease; due to simultaneous plaque formations at other locations, due high cholesterol levels in the body

How is Carotid Artery Disease Treated?

The general steps that a physician may consider to manage Carotid Artery Disease are mainly meant to prevent any medical emergency incidences. These include:

  • Use of medications (for mild to moderate atherosclerosis) to lower blood pressure (like calcium channel blockers, beta blockers, water pills), prevent blood clots (using anti-platelet drugs), limit the progression of plaque buildup (with ACE inhibitors), lower cholesterol levels (with statins, fibrates)
  • Surgical procedures are adopted when the condition is serious with severe blood flow obstruction, or when a TIA/stroke is noticed. Two surgical intervention techniques used are: Carotid endarterectomy (invasive procedure to remove plaque, replace portion of the artery), and carotid angioplasty with stenting (using inflated catheter and placing a stent to prevent narrowing of the artery)
  • Passive management of the condition by bringing about changes to the lifestyle, such as avoidance of smoking, high-fat, high-salt diets; limiting alcohol consumption; regular exercising; having a healthy diet; and managing stress

How can Carotid Artery Disease be Prevented?

Carotid Artery Disease can be prevented, if the risk factors that lead to the condition are controlled, and the progress rate of plaque-formation reduced. The measures to be taken include:

  • Smoking has to be completely avoided, and alcohol consumption controlled (limit to a minimum, if possible)
  • Individuals have to minimize their stress, and always maintain blood pressure within acceptable levels
  • A healthy diet, rich in fruits, vegetables, fish, whole grains, and low in fats and sugar, delays any build-up of plaque
  • Be aware of preliminary signs and symptoms of TIA (in particular) and stroke
  • Be aware of signs and symptoms of atherosclerosis-related diseases, chiefly if your age is over 50 years. Have periodic medical health check-ups, more so if the risk factors apply to you
  • Maintain a healthy weight, exercise regularly, and be physically active
  • If you are diabetic, then always have your blood sugar maintained under control

What is the Prognosis of Carotid Artery Disease? (Outcomes/Resolutions)

  • Carotid Artery Disease may remain asymptomatic and may not be noticed until a medical complication, such as a stroke develops
  • The prognosis is dependent on the intensity of the stroke, establishment of an early treatment procedure, the part of the head/brain affected, and many other factors
  • An advancing age and genetic parameters cannot be changed; but, modifications to lifestyle may keep atherosclerosis from progressing to a life-threatening situation

Additional and Relevant Useful Information for Carotid Artery Disease:

Stroke, caused by Carotid Artery Disease, is a leading killer. More than 50% of strokes that occur are due to plaque build-up, in the carotids.

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 13, 2013
Last updated: March 23, 2018