Understanding carotid artery disease

Carotid artery disease is a leading cause of stroke, but screening and treatments are available to help keep it under control.

Carotid arteries are blood vessels on either side of your neck that deliver blood to your face, head and brain. Like other blood vessels, carotid arteries can become narrowed over time by the buildup of plaque. This is known as carotid artery disease and is a leading cause of stroke.

How do you know if you have carotid artery disease?

Unfortunately, carotid artery disease is often silent — until you get to the point of having a stroke. “The good news,” said Christy Guth, M.D., a vascular surgeon at Vanderbilt Integrated Surgery, “is that we have ways of screening for it. Even if you’re asymptomatic, it’s important for us to know if you have carotid artery disease, as it’s indicative of the rest of your vascular health. There are things we can do to prevent issues down the road, not only in terms of stroke but in terms of your overall heart health.”

Carotid artery disease screening

According to the latest recommendations from the U.S. Preventive Services Task Force, said Guth, you need to be over the age of 65, plus have a risk factor to meet the screening criteria. “If you’re a smoker; if you have a history of high cholesterol; if you have other known vascular disease, such as coronary artery disease or peripheral artery disease; if you’ve had a stent placed or a bypass or a similar procedure — these are all risk factors,” Guth said. “Vascular disease somewhere means vascular disease everywhere.” Screening for a carotid artery blockage typically involves blood tests and imaging exams, such as ultrasound.

Treatment options for asymptomatic patients

If screening indicates carotid artery disease but you do not have any symptoms, the next steps are usually to make sure you’re on an antiplatelet medication such as aspirin and to make sure your cholesterol is being aggressively managed. “We frequently start patients on statin therapy, as well, to help stabilize the plaque so it’s less likely to cause a stroke,” Guth explained. “But really, most of my time is spent talking to people about smoking cessation, which is critically important to the successful management of carotid artery disease.”

Symptoms of a carotid artery blockage

The symptoms you’d expect from a stroke are the symptoms associated with carotid artery disease: slurred speech; inability to move part of the body or part of the face; arm numbness or weakness; blindness in one eye.

“We’re concerned even if you’ve had symptoms that lasted for only a few seconds,” Guth said. “For example, a common symptom patients experience is that they feel like a shade has been pulled down over the eye. It can last for only a few seconds, or 10 minutes, or a day. They might say, ‘Oh, my eye kind of went dark for a minute.’ But for us, that’s a huge red flag.”

Treatment options for symptomatic patients

If you’re having symptoms and are otherwise healthy enough to undergo surgery, that’s typically the first course of action, because the risk of stroke is high. There are multiple options for surgical treatment that you and your vascular surgeon can discuss and customize to your health needs.

After undergoing a surgical treatment, patients are monitored closely, usually receiving an ultrasound one month and six months post-procedure, and then on an annual basis. “We’re actively monitoring, so we’re able to detect any narrowing that might arise,” Guth said. “Your vascular surgeon will become an important part of your care team moving forward to make sure we optimize your vascular health.”