Carotid Artery Stenosis is a disease state that occurs when atherosclerotic plaque builds up within the right and left carotid arteries found in the neck. This obstruction can lead to a reduction of blood flow to the brain, face and neck. Most plaque build-up is typically caused due to higher cholesterol and lipid levels that are deposited within the arterial walls over time.1
The incidence of carotid stenosis varies depending on the patients’ age and individual risk factors, however:
Women and men have similar incidences of carotid stenosis up until 70 years of age when men then appear to have a higher incidence after this age compared to women in the same age group.2
Carotid artery stenosis may produce little if any symptoms in the earliest stages of the condition and can be undiagnosed for many years until more significant symptoms present. The symptoms are usually a direct result of the fatty deposits within the carotid arteries that reduce the blood flow to the brain, and either temporarily or chronically deprive the brain of blood.
For many patients, the first presentation of this disease can be during a Transient Ischaemic Attack (TIA) or a Stroke. These symptoms may include:
In the case of a TIA, these symptoms may resolve over a short period of time with little to no treatment. However, in the case of a stroke, the symptoms may not resolve without treatment.
Should any of the above symptoms present, this would be considered a medical emergency and patients should immediately go to their nearest hospital or call a local ambulance.4
Commonly, carotid artery stenosis is caused by plaque build-up within the arterial wall which may reduce blood flow to the brain, face and neck. This is often associated with Hyperlipidaemia, a condition which leads to atherosclerotic plaque-forming within the blood vessel walls, in turn, reduces the internal dimension of the blood vessel.
Other causes of carotid artery stenosis may include:
Occasionally, blood vessels may be damaged if small pieces of plaque crack and rupture. This process can lead to platelets clumping together and forming blood clots around the site of the injury and may reduce blood flow through the carotid artery caused by the newly formed blood clot, leading to symptoms.5
Formal diagnostic tests for carotid artery stenosis are typically performed after a patient has presented or there’s a high suspicion of having either a Transient Ischaemic Attack (TIA) or a Stroke. Occasionally a physician may hear a “bruit” when listening (auscultating) the carotid artery using a stethoscope. This may occur during a physical assessment of a patient by a General Practitioner or another medical specialist.
A “Bruit” may also be referred to as a “murmur” heard when listening to the carotid artery, which can indicate there’s an abnormal flow or obstruction through the arteries.6
Imaging diagnostic options may include:
Depending on the level of obstruction that has been identified using specific diagnostic approaches, there are three recognised levels of carotid artery stenosis which can influence treatment options.