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The carotid arteries run along both sides of the neck, supplying the brain with oxygenated blood to help it manage all the body’s functions. But when a patient develops carotid artery stenosis (CAS), it can lead to a stroke with irreversible consequences.
Carotid artery stenosis (CAS) is the narrowing of the inside of the arteries due to a buildup of plaque, which are fatty deposits that reduce blood flow to the brain. As more plaque accumulates, it can break off, blocking the flow of blood and causing an ischemic stroke.
According to the U.S. Centers for Disease Control and Prevention, 80% of strokes are preventable—and CAS is one of the most preventable causes of stroke. About 20% of patients who have an ischemic stroke have CAS.
Exercise and eating a heart-healthy diet can help reduce the risk. MedStar Health offers screening for people at risk of CAS, even if they don’t have symptoms yet, and advanced treatments—such as minimally invasive surgery—to improve blood flow in the carotid arteries and reduce the risk of stroke.
Who should be screened for CAS?
Everyone who has a risk factor for plaque buildup should be screened for CAS. Anyone who’s at risk for developing plaque will be at risk for it depositing in their carotid arteries, especially if you smoke or have diabetes or high blood pressure.
Several risk factors can increase the likelihood you’ll develop CAS, including:
- Advanced age, especially in males
- Diabetes
- Family history of stroke
- High blood pressure, high cholesterol, or high triglycerides
- Neck trauma
- Smoking tobacco
Symptoms of CAS include vision loss in one eye, weakness, numbness, and speech problems. However, in about 0.5% of people younger than 50 and 10% of people over 65, CAS has no symptoms.
We screen for CAS with a non-invasive and easy ultrasound, which captures images of the arteries to check for narrowing. If you have carotid artery stenosis, your doctor will discuss the best treatment to help you avoid a stroke. Your doctor will consider your age, health and medical history, and the severity of artery blockage when deciding upon the best treatment.
What medications can treat CAS?
Often, carotid arteries less than 50% narrowed are treated with medications and lifestyle changes. Lifestyle changes that can benefit your arteries include:
- Quit smoking
- Eat a low-fat, low-cholesterol diet
- Control glucose with a low-sugar diet and exercise
- Exercise to maintain healthy weight
- Lower blood pressure to reduce wear and tear on arteries
Medications to treat CAS include:
- Antiplatelet medicines: Aspirin, clopidogrel, and dipyridamole are all examples of medicines that cause the blood to stick together less, avoiding clots.
- Cholesterol medicines: Statins like simvastatin and atorvastatin can lower cholesterol. Studies have shown they can also decrease the thickness of the carotid artery wall and increase its opening.
- Blood-pressure lowering medicines: There are several medications that help lower blood pressure to less than 140/90, which is recommended for most people.
When the carotid artery is more than 70% narrowed, surgery is usually recommended.
Related reading: Why Are Women Less Likely to Take Statins?
What surgical procedures can treat carotid artery stenosis?
Carotid endarterectomy (CEA) has been the gold-standard CAS surgery since the 1950s. Procedures have evolved over time, but the goal remains the same: remove plaque from the carotid artery and restore normal blood flow.
CEA can be done under ether general or local anesthesia. After making an incision in the front of the neck to access the artery, the surgeon often uses a temporary device called a shunt to detour blood flow around the carotid artery while they remove its inner lining and plaque buildup. At MedStar Health, our neurologists provide the surgeon with real-time data about the nervous system during the operation to maintain the highest levels of safety.
Once the artery is clear, the surgeon closes it with a graft and removes the shunt. The procedure usually takes an hour or two, and most patients can return to work in three to four weeks.
Transfemoral Carotid Artery Stenting (TF-CAS) is a less invasive technique to help clear plaque buildup. This endovascular procedure requires only a small incision in the groin. The surgeon threads a small wire through the arteries, up the abdomen until it reaches the blockage in the carotid artery.
There, a small filter keeps pieces of plaque from traveling to the brain. The surgeon inserts a mesh tube called a stent that covers the plaque and keeps the artery open. Most patients go home the day after the procedure and return to normal activities within a few days. Research has shown patients are more likely to have a stroke during TF-CAS than other CAS procedures.
Transcarotid artery revascularization (TCAR) is less invasive that the carotid endarterectomy and the latest intervention to treat CAS. The surgeon temporarily directs blood into a filter to make sure no plaque that breaks off reaches the brain.
A stent is placed in the carotid artery, widening the artery and increasing blood flow to the brain. TCAR reduces the risk of stroke and the chances of nerve damage that can result from CEA. Most people return home the day after TCAR and can return to usual activities within a week.
After surgery, it’s important to stay on your medications and make lifestyle changes to help your heart and blood vessels stay healthy.
Stroke can cause permanent harm to the brain. Only about 50% of patients recover from their first ischemic stroke well enough to return to work, and about 25% of people will have another stroke. With so much at stake, it’s critical to prevent CAS and diagnose it as soon as possible. Working with a specialist to treat and manage CAS can significantly reduce the risk of death or long-term impairment from stroke, protecting the brain and preserving its function.
