Carotid atherosclerotic disease
Einstein Health Glossary
ICD 10 - I652
What is carotid atherosclerotic disease?
The carotid arteries are the main source of blood flow to the brain and are located on both sides of the neck.
Carotid atherosclerotic disease, or carotid stenosis, occurs when there is a narrowing or blockage of blood flow in the carotid arteries due to atherosclerotic plaques, which are formed by substances such as fat and calcium. This phenomenon is known as atherosclerosis.
Small fragments of fat or a clot may detach from the plaques and cause an ischemic stroke or cerebrovascular accident (CVA).
Blockage of the carotid arteries is responsible for approximately 15% of ischemic stroke cases.
Causes
- advanced age
- diabetes
- smoking
- hypertension
- high cholesterol
- obesity
- physical inactivity
- family history of atherosclerosis
Symptoms
Carotid atherosclerotic disease does not cause symptoms in its early stages.
In most cases, the first manifestation of the disease is a stroke, and in some cases, a “warning sign,” meaning temporary symptoms known as a transient ischemic attack (TIA). The most common symptoms of a stroke or TIA related to carotid disease are:
- weakness or tingling on one side of the body
- difficulty seeing out of one eye
- loss of balance or sudden difficulty walking
- trouble speaking or understanding
These symptoms usually appear suddenly and should not be ignored, even if they improve spontaneously within a few minutes. Immediate medical attention is essential for proper diagnosis and timely treatment.
Diagnosis
After a detailed medical history and physical examination, the doctor may request several types of complementary tests to confirm or rule out carotid disease, such as:
- carotid artery Doppler ultrasound
- magnetic resonance angiography (MRA)
- computed tomography angiography (CTA)
- digital angiography
Each test provides different information about the atherosclerotic plaque and should be ordered by your physician. Not all tests may be necessary, but using at least two or more methods can help guide the best treatment decision.
Treatment
Treatment depends on the severity of the disease, the presence or absence of symptoms, the degree of stenosis, and the patient’s overall health. There are three main options:
- medical treatment: involves medications such as antiplatelet agents to prevent clot formation on the plaque; cholesterol-lowering drugs like statins; lifestyle changes including a healthy diet, physical activity, smoking cessation; and control of associated conditions like diabetes and high blood pressure, as directed by your doctor
- surgery – endarterectomy: usually performed under general anesthesia, this procedure involves an incision in the neck to expose and open the carotid artery, followed by removal of the atherosclerotic plaque
- angioplasty with stent placement: may be done under local or general anesthesia. A catheter is inserted, usually through the femoral artery in the groin, and guided to the carotid artery. A filter is often used to prevent small fragments from reaching the brain. A stent (a small metal mesh tube) is then placed at the site of narrowing to widen the artery and restore blood flow
The best treatment option should be discussed between you, your family, and your doctor. Be sure to ask all your questions!
If surgery or angioplasty is recommended, you will be followed by a multidisciplinary team from admission to discharge. After the procedure, the clinical outcomes team will contact you by phone at 1 month, 6 months, and 1 year.
Postoperative Care
In the immediate postoperative period, blood pressure instability is very common. The patient should remain under monitoring for at least 24 hours in the intensive care unit (ICU), where neurological and cardiac complications are also closely monitored.
After 24 hours in the ICU, if no complications arise, the patient may be transferred to a regular hospital room. After hospital discharge, any neurological or cardiac changes should prompt immediate medical attention.
Watch for symptoms such as persistent headache, tingling or weakness on one side of the body, difficulty speaking or understanding, vision problems, chest pain, shortness of breath, or palpitations. Follow your doctor’s instructions regarding medications—never stop taking prescribed medications without guidance—and attend all recommended follow-up appointments. Wait for medical clearance before resuming your usual activities.