Narrowing of the Carotid Artery – Carotid Stenosis
The carotid arteries are the main arteries in the neck that supply blood to the brain. As we age, calcifications, known as plaques, often form in these arteries. They cause narrowing of the carotid artery (carotid stenosis), where blood clots can form. If these clots break loose and travel with the bloodstream to the brain, they can cause a stroke.
Risk factors
The risk factors are:
- high blood pressure
- Smoking
- Elevated blood lipid levels (hyperlipidaemia)
- Diabetes
- Lack of exercise
- Poor diet
Frequency
Carotid stenosis is responsible for up to a third of all strokes.
Warning signs
Narrowing of the carotid artery is often asymptomatic and is only detected by chance during an ultrasound examination. In many cases, however, warning symptoms caused by temporary circulatory disorders in the brain occur before a stroke. These can include temporary visual disturbances, speech disorders or paralysis (arms and legs). These symptoms subside after a few minutes or hours. Temporary double vision, sudden severe headaches and dizziness are also warning signs. Symptoms such as these are alarm signals and require urgent medical attention.
Diagnosis
If the above symptoms occur, it is absolutely necessary to examine the carotid artery for narrowing (stenosis).
- The ultrasound examination is completely safe, painless and does not involve any radiation exposure. This examination can be used to assess dangerous calcifications caused by arteriosclerosis and the resulting narrowing of the carotid artery.
- CT angiography or MRI is often performed in addition to enable assessment of the branches of the neck vessels from the aorta and the cerebral vessels in the head.
Treatment
- The first and most important measure is to treat the risk factors. High blood pressure, diabetes and high blood lipid levels must be treated with medication.
- The vascular specialist decides whether carotid stenosis can and must be treated directly, depending on its extent.
- Carotid stenosis is most commonly treated with surgery. Alternatively, stents can also be used under certain conditions.
Surgery
The surgery is performed under local or general anaesthesia. The carotid artery is exposed via an incision in the neck and the narrowing is then removed. Depending on the findings, a small "patch" (known as patch plasty) is sewn in or the carotid artery is sutured directly. During the operation, blood flow to the brain is continuously monitored in order to detect any circulatory disorders in good time. Overall, this is a low-complication procedure that can protect patients from the consequences of a stroke. The inpatient stay in the clinic is only a few days.
Aftercare
Surgery is only part of the treatment. In principle, all other diseases and risk factors for arteriosclerosis (smoking, high blood pressure, diabetes, elevated blood lipids and increased body weight) must be controlled or treated with medication. All of this must be done in consultation with your treating physician.
In episode 2 of our podcast "Focus on blood vessels", you can learn more about carotid stenosis.