Carotid Artery Disease: Symptoms, Causes & Treatment

What is Carotid Artery Disease?

Carotid artery disease is a condition in which the carotid arteries become narrowed or blocked, restricting blood flow to the brain. The carotid arteries are two large blood vessels located on either side of the neck that supply oxygen-rich blood to the brain, neck, and face. It is primarily caused by atherosclerosis, a buildup of fatty plaques made up of cholesterol, calcium, and other substances along the artery walls. These plaques can narrow or block the arteries, reducing blood flow to the brain. If left untreated, carotid artery disease can lead to a stroke or mini-stroke, which can cause permanent brain damage or even death.

How Carotid Artery Disease Develops

Carotid artery disease develops gradually over time as a result of atherosclerosis, a process in which cholesterol, fat, and other substances accumulate on the inner walls of the carotid arteries, forming plaque. As plaque builds up, it narrows the arteries and reduces blood flow to the brain. If a plaque ruptures, it can trigger the formation of a blood clot that may completely block the artery or break off and travel to the brain, causing a stroke.

Causes of Carotid Artery Disease

Atherosclerosis

The primary cause of carotid artery disease is atherosclerosis, a gradual process in which plaques composed of cholesterol, fatty substances, calcium, and cellular debris build up on the inner walls of the arteries. Over time, this accumulation of plaque hardens and narrows the arteries, restricting blood flow and increasing the risk of blood clots.

Other Contributing Factors

• High blood pressure (hypertension)
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Physical inactivity
• Family history of atherosclerosis or cardiovascular disease
• Older age
• Unhealthy diet high in saturated fats and cholesterol

Risk Factors for Carotid Artery Disease

Carotid artery disease, a leading cause of stroke, is influenced by various risk factors. According to the UCSF Department of Surgery, these include:

• Older age (especially over 65)
• Male sex
• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Obesity
• Physical inactivity
• Family history of carotid artery disease, stroke, or heart disease
• Unhealthy diet
• Sleep apnoea

Symptoms of Carotid Artery Disease

• Often there are no carotid artery disease symptoms in early stages
• Sudden numbness or weakness in the face or limbs, often on one side
• Difficulty speaking or understanding speech
• Sudden loss of vision or blurred vision, especially in one eye
• Dizziness, loss of balance, or coordination problems
• Severe headache with no known cause

Warning Signs of a TIA (Mini-Stroke)

• Sudden weakness or numbness in the face, arm, or leg (usually on one side)
• Trouble speaking or understanding speech
• Sudden vision loss in one or both eyes
• Sudden dizziness, trouble walking, or loss of balance/coordination
• Mini-stroke symptoms typically last a few minutes to a few hours and completely resolve within 24 hours.

Complications of Untreated Carotid Artery Disease

• Stroke (permanent brain damage or death)
• Transient ischemic attack (TIA)
• Permanent disability (speech, movement, vision loss)
• Cognitive impairment
• Death

How Carotid Artery Disease is Diagnosed

1. Medical History & Physical Exam

If your healthcare provider suspects you have carotid artery disease, they will review your medical history and risk factors and perform a physical exam. During the exam, they may listen for a whooshing sound (bruit) over the carotid artery, which can indicate turbulent blood flow due to narrowing of the artery. However, not all bruits signal severe disease.

2. Carotid Ultrasound

A carotid ultrasound is a non-invasive test that uses sound waves to create images of the carotid arteries and measure blood flow. This test can detect narrowing, blockages, and the characteristics of any plaques present in the arteries.

3. Imaging Tests

• CT scan or CT angiography (uses X-rays to provide detailed images of blood vessels)
• Magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA)
• Catheter-based cerebral angiography (gold standard but invasive) — uses contrast dye and X-rays to provide detailed imaging of arteries

4. Blood Tests

Your healthcare provider may order blood tests to check your cholesterol levels, blood sugar (for diabetes), and other markers of cardiovascular risk that contribute to plaque formation.

Treatment for Carotid Artery Disease

Carotid artery disease treatment focuses on reducing the risk of stroke and improving blood flow to the brain. Depending on the severity, treatment may include lifestyle changes, medications, or surgical procedures to manage the condition effectively.

Lifestyle Changes

• Quitting smoking
• Eating a heart-healthy diet low in saturated fat, cholesterol, and sodium
• Regular physical activity
• Achieving and maintaining a healthy weight
• Managing blood pressure, cholesterol, and diabetes

Medications

• Antiplatelet agents (e.g., aspirin or clopidogrel) are prescribed to prevent clot formation and reduce stroke risk, particularly in symptomatic carotid artery disease or after surgical interventions.
• Statins to lower LDL cholesterol levels and stabilise atherosclerotic plaque, thereby reducing stroke risk.
• Blood pressure medications (antihypertensives)
• Medications to control diabetes

Surgical Procedures

• Carotid endarterectomy (CEA), the surgical removal of plaque from the carotid artery, is usually recommended for patients with ≥70% narrowing, or 50–69% in select symptomatic patients.
• Carotid artery angioplasty and stenting, where a balloon is used to widen the artery, and a stent is placed to keep it open.

Prevention of Carotid Artery Disease

• Avoid smoking and tobacco products.
• Eat a balanced diet with plenty of fruits, vegetables, whole grains, and lean proteins.
• Keep a healthy weight.
• Stay active with regular exercise.
• Monitor and manage blood pressure, cholesterol, and blood sugar levels.
• Find ways to reduce and manage stress.
• Visit your doctor regularly for check ups and screenings.

Living with Carotid Artery Disease

Living with carotid artery disease requires long-term management of risk factors and adherence to treatment plans. This typically involves making lifestyle changes, taking prescribed medications, monitoring blood pressure and cholesterol levels, and having regular follow-up appointments with your healthcare provider. Early and ongoing management can help reduce your risk of stroke and improve your overall quality of life.

When to Seek Emergency Medical Care

• Sudden numbness or weakness in the face, arm, or leg (especially on one side)
• Sudden difficulty speaking or understanding
• Sudden vision loss or blurred vision
• Sudden dizziness or loss of balance/coordination
• Severe, sudden headache with no known cause
• Any symptoms of a TIA or stroke, even if they resolve

Conclusion

Early detection, risk factor modification, medical treatment, and sometimes surgery are critical to preventing stroke and improving carotid artery disease treatment outcomes. By adopting a heart-healthy lifestyle, attending regular checkups, and working closely with your healthcare provider, you can effectively manage carotid artery disease and reduce your risk of serious complications.

At Metropolis Healthcare, we understand the importance of early detection and personalised care in managing conditions like carotid artery disease. With a simple blood test, we can assess your cholesterol levels and other markers of cardiovascular risk, empowering you to make informed decisions about your health. Committed to providing accuracy, quality, and personalised care, with a CAP-proficiency score exceeding 98%, Metropolis is here to support you in prioritising your family's health and well-being.

FAQs

What is the main cause of carotid artery disease?

The main cause of carotid artery disease is atherosclerosis, the gradual buildup of fatty plaque in the artery walls. This process leads to the narrowing and hardening of the carotid arteries, restricting blood flow to the brain and increasing the risk of stroke.

Can carotid artery disease be reversed?

While carotid artery disease cannot be fully reversed, its progression can be slowed or stabilised with lifestyle changes, medication, and sometimes surgical procedures. Early intervention is key to reducing your risk of stroke and managing the condition effectively.

What foods are good for carotid artery health?

Foods that promote carotid artery health include fruits, vegetables, whole grains, lean proteins (especially fish), nuts, seeds, and foods low in saturated fat, cholesterol, and sodium. Avoiding trans fats, processed foods, and sugary beverages is also beneficial for maintaining healthy carotid arteries.

How serious is carotid artery blockage?

Carotid artery blockage is a very serious condition. Severe narrowing or blockage can lead to a stroke, which can result in permanent disability or death if left untreated. It's crucial to address carotid artery disease as early as possible to reduce your risk of these life-altering complications.

What is the difference between a TIA and a stroke?

A transient ischaemic attack (TIA), often called a mini-stroke, involves a temporary blockage of blood flow to the brain, causing stroke-like symptoms that usually resolve within 24 hours and leave no permanent damage. In contrast, a stroke causes a longer-lasting blockage and can result in permanent brain injury or death.

References

• https://surgery.ucsf.edu/condition/carotid-artery-disease
• https://www.mayoclinic.org/diseases-conditions/carotid-artery-disease/symptoms-causes/syc-20360519
• https://www.aao.org/eye-health/diseases/what-is-carotid-artery-disease
• https://my.clevelandclinic.org/health/diseases/16845-carotid-artery-disease-carotid-artery-stenosis