In brief: The carotid arteries in the neck supply blood to the brain. Narrowing due to atherosclerosis can lead to stroke. In suitable patients, treating the narrowing (endarterectomy or stent) helps prevent stroke.
Carotid Artery Disease
Plaque build-up narrows the carotid artery; fragments can travel to the brain and cause a stroke. Risk is higher with high blood pressure, high cholesterol, diabetes and smoking. Narrowing is detected with colour Doppler ultrasound.
Treatment & Stroke Prevention
In selected patients, the narrowed artery is treated by carotid endarterectomy (removing the plaque) or stenting, reducing the risk of stroke. Warning signs of stroke (sudden face drooping, arm weakness, speech difficulty) require calling emergency services immediately.
What Are the Symptoms?
Carotid artery narrowing often progresses silently and may be discovered incidentally during an examination for another reason. When it does cause symptoms, these usually appear as a transient ischaemic attack (TIA) or a stroke. Common warning signs include:
- Sudden, temporary loss or blurring of vision in one eye
- Sudden weakness or numbness on one side of the body (arm, leg or face)
- Difficulty speaking or understanding speech
- Sudden loss of balance or dizziness
The “FAST” rule for stroke: Face (drooping), Arm (weakness), Speech (difficulty), Time (call emergency services without delay). Even if the symptoms pass quickly (a transient ischaemic attack), they should not be ignored; they may herald an approaching stroke and require urgent assessment.
Carotid Disease and Its Link to Stroke
Stroke is among the leading causes of long-term disability, and a significant proportion of strokes originate from the carotid arteries. Detecting carotid narrowing early and treating it appropriately plays a decisive role in stroke prevention. The risk of stroke is particularly high in the first weeks after a transient ischaemic attack, so assessment should not be delayed.
Risk Factors
- High blood pressure
- High cholesterol and hardening of the arteries (atherosclerosis)
- Smoking
- Diabetes
- Older age and a family history of vascular disease
Diagnosis
The first and most commonly used method to assess the carotid arteries is colour Doppler ultrasound; it is painless and shows the degree of narrowing in the vessel. When more detail is needed, CT angiography or MR angiography can be used for a more thorough evaluation. The carotid arteries should always be examined in anyone who has had a stroke or transient ischaemic attack.
Treatment Options
Treatment is planned according to the degree of narrowing, whether symptoms are present, and the patient’s overall condition.
1. Medical Treatment and Risk Control
At every stage, controlling blood pressure, cholesterol and blood sugar, stopping smoking, and following the medication your physician considers appropriate (for example a blood thinner) are important. Low-grade narrowing that causes no symptoms is often managed and monitored in this way.
2. Carotid Endarterectomy (Surgery)
This is the surgical removal of the plaque causing the narrowing. In general medical practice, it is considered effective for preventing stroke in patients who have symptoms (a previous stroke or TIA) and severe narrowing (roughly above 70%). It may also be considered in suitable candidates with severe narrowing that has not yet caused symptoms. Prof. Dr. Yusuf Kalko’s published work in this field relates to performing carotid endarterectomy under local anaesthesia; because the patient can remain awake, neurological function can be monitored directly during the procedure.
3. Carotid Stenting (CAS)
This involves placing a stent inside the artery, accessed through the groin or neck. It may be considered as an option particularly in patients for whom open surgery carries a higher risk. Which method is appropriate is specific to each patient and is determined by the physician. In selected cases where blood flow to the brain is severely compromised, procedures to reopen a blocked or narrowed vessel within a certain period after a stroke may also be considered. These decisions are entirely individual and depend on the clinical situation.
Hybrid Approach in the First 6 Hours of a Stroke
The first hours after stroke symptoms begin are critical for protecting brain tissue. In selected cases of sudden, complete carotid blockage (acute occlusion) — particularly within the first 6 hours of symptoms — a hybrid approach that combines open surgery with catheter-based techniques in the same session may be considered as an important option to rapidly reopen the blocked vessel and restore blood flow to the brain. This decision is made by an experienced team based on the patient’s clinical condition, imaging findings and the time elapsed.
Frequently Asked Questions
Why is carotid narrowing important?
Fragments from the narrowed artery can travel to the brain and cause a stroke; early diagnosis allows preventive treatment.
How is it treated?
In suitable patients by endarterectomy (plaque removal) or stenting, to reduce stroke risk.
Is this medical advice?
No. This page is for information only; please consult a physician for diagnosis and treatment.
Does carotid narrowing cause symptoms?
It often progresses silently. When it does cause symptoms, these usually appear as temporary stroke-like signs (TIA) such as brief vision loss, weakness on one side, or speech difficulty.
How are the carotid arteries checked?
Colour Doppler ultrasound is used most often; when needed, CT or MR angiography provides a more detailed assessment.
Which narrowings are operated on?
In general, surgery (carotid endarterectomy) is considered effective at preventing stroke in symptomatic patients with severe narrowing (roughly above 70%). Suitable candidates with severe but symptom-free narrowing may also be evaluated. The decision is individual.
What is the difference between carotid surgery and a stent?
Endarterectomy is the surgical removal of the plaque; stenting places a stent inside the artery. Which is appropriate depends on the patient’s condition and vessel anatomy.
Which specialty treats carotid artery disease?
Carotid (neck artery) disease falls within the field of cardiovascular surgery.
What is the carotid artery?
It is the main artery on each side of the neck that carries blood from the heart to the brain.
What causes carotid narrowing?
The most common cause is hardening of the arteries (atherosclerosis); fatty and calcified plaque builds up in the vessel wall and narrows it.
How does carotid narrowing lead to stroke?
The narrowing can reduce blood flow to the brain, and fragments breaking off the plaque can block brain vessels, causing a stroke or transient ischaemic attack.
How is carotid endarterectomy performed?
The plaque in the artery is removed surgically; in suitable patients it can be done under local anaesthesia while the patient is awake, so brain function can be monitored.
When is non-surgical follow-up appropriate?
For low-grade narrowing that causes no symptoms, follow-up with medication and risk-factor control is usually preferred.
Can carotid narrowing be prevented?
Controlling blood pressure, cholesterol and blood sugar, stopping smoking and a healthy lifestyle reduce the risk and slow the progression of narrowing.
Video — Prof. Dr. Yusuf Kalko
Prof. Dr. Yusuf Kalko explains whether stroke can be prevented. (Video in Turkish.)
Related
Peripheral Artery Disease · Aortic Aneurysm · Minimally Invasive Vascular Surgery
This content is for information purposes only and does not replace a medical consultation. Diagnosis and treatment require an in-person examination. — Cardiovascular Surgeon Prof. Dr. Yusuf Kalko