Carotid Artery Stenosis

Carotid artery stenosis is a narrowing of the large blood vessels in the neck that supply oxygen-rich blood to the brain. This narrowing is typically caused by a buildup of plaque (atherosclerosis) and is a leading cause of ischemic stroke. Timely evaluation and intervention can significantly reduce the risk of a devastating stroke.

What Is Carotid Artery Stenosis?

Carotid artery stenosis occurs when the carotid arteries become narrowed or blocked by atherosclerotic plaque. As the plaque builds up, it reduces blood flow to the brain and creates a risk that a piece of plaque or a blood clot could break off and travel to the brain, causing a transient ischemic attack (TIA) or a stroke. It is most common in older adults and those with vascular risk factors.

At a Glance

Carotid artery stenosis is a primary cause of ischemic stroke, resulting from plaque buildup in the neck arteries
Many patients are asymptomatic until a TIA or stroke occurs
Diagnosis is easily made with a non-invasive carotid ultrasound
Medical management with statins and antiplatelet agents is the foundation of treatment
Surgical options (carotid endarterectomy or stenting) are indicated for symptomatic patients with >50% stenosis or asymptomatic patients with >70% stenosis

Symptoms

Diagnosis

Carotid Doppler ultrasound — the standard first-line screening tool; measures the velocity of blood flow to estimate the degree of narrowing
CT Angiography (CTA) or Magnetic Resonance Angiography (MRA) — provides highly detailed 3D images of the neck and brain blood vessels to confirm the degree of stenosis and plan for surgery
Digital subtraction angiography (DSA) — the historical gold standard, now typically reserved for complex cases where non-invasive imaging is inconclusive

Types

Treatment

Medical Management — essential for all patients. Includes aggressive blood pressure control, lipid-lowering therapy (statins), antiplatelet medications (aspirin or clopidogrel), and smoking cessation.
Carotid Endarterectomy (CEA) — the gold standard surgical procedure for severe stenosis. The surgeon opens the artery and physically removes the plaque. Highly effective at preventing future strokes with a low perioperative risk.
Transcarotid Artery Revascularization (TCAR) — a newer, minimally invasive approach where a stent is placed through a small incision at the base of the neck, while blood flow is temporarily reversed to protect the brain from plaque debris.
Carotid Artery Stenting (CAS) — a minimally invasive endovascular procedure using a catheter from the groin or wrist to deploy a stent that holds the artery open. Often used for patients who are high risk for open surgery.

Outcomes

Treatment	Stroke Prevention Efficacy	Notes
Medical Management alone	Effective for mild-to-moderate or asymptomatic disease	Requires strict adherence to medications and lifestyle changes
Carotid Endarterectomy (CEA)	Excellent long-term stroke reduction	Gold standard for symptomatic >50% and asymptomatic >70% stenosis
TCAR / Carotid Stenting	Comparable to CEA in appropriately selected patients	Minimally invasive options with shorter recovery times

References

Our Specialists

Issam A. Awad, MD

Neurosurgery

Sean P. Polster, MD

Neurosurgery

Omer Doron, MD, PhD

Neurosurgery

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