The carotid arteries supply blood to the brain. Carotid artery disease is a build-up of plaque (atherosclerosis) in these arteries. Plaque reduces blood flow and causes turbulence which may lead to clot formation. The plaque may also become inflamed and crack further, generating clot and inflammatory material. The passage of clot or solid material to the brain arteries can block flow and cause stroke or mini stroke. A mini stroke is also called a transient ischaemic attack (TIA).
Common symptoms of TIA include brief attacks of weakness, clumsiness, numbness or pins and needles of the face, arm or leg on one side of the body. The eye can also be affected resulting in loss of vision in one eye, called amaurosis fugax. A full stroke lasts longer than a mini stroke and can be permanently disabling or fatal.
Carotid artery disease is one of the most common causes of stroke. Up to one half of all strokes occur because of it, other causes include brain tumours or clots from the heart.
The diagnosis is usually made with an ultrasound scan of the arteries in the neck (duplex) and sometimes a CT or MR scan.
All patients with carotid artery disease can benefit from taking aspirin (by reducing blood clotting) and a statin (by reducing plaque build up). Treatment of their individual risk factors for plaque build up, in particular, stopping smoking completely can also be beneficial.
There is good evidence that those people with narrowings greater than about 70% of the diameter of the artery will significantly reduce their chance of developing stroke by undergoing surgery. The surgery is called carotid endarterectomy and involves removing the plaque and repairing the artery. For those patients who have suffered a mini stroke, carotid endarterectomy should be performed as early as possible to help prevent further stroke. Carotid disease can also be treated using the less invasive procedure of endovascular stenting however current evidence suggests that for most people surgery is safer.