Carotid Artery Disease

What is Carotid Artery Disease?

Carotid artery disease is a serious condition in which the carotid arteries (the blood vessels that bring oxygen to the brain) become narrow or blocked. It is a common cause of life-threatening strokes or transient ischemic attacks.

The carotid arteries are located in the neck and provide the brain with most of its blood supply. Carotid artery disease develops when these arteries become narrowed, or occluded, by an accumulation of a fatty substance called plaque. The build-up of plaque inside the walls of the artery is due to a process called atherosclerosis (hardening of the arteries), and the resulting narrowing is called stenosis. If plaque builds up to the point that it obstructs blood flow to the brain, or particles of the plaque break off and travel to small arteries within the brain, a person can develop a stroke or a mini stroke called “transient ischemic attack” (TIA). Stroke is an emergency condition requiring prompt treatment to prevent permanent brain injury.

Carotid artery disease causes more than half of all strokes. Stroke is the third highest cause of death and the leading cause of disability in the United States. Patients with carotid artery disease need specialized vascular care, like that found at NewYork-Presbyterian. Combining the expertise of our vascular specialists with the latest technologies and resources available at our two renowned medical centers—NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian/Weill Cornell Medical Center—you’ll receive sophisticated, personalized care designed to meet your needs and enhance your quality of life.

Signs & Symptoms

Carotid stenosis is often a silent condition – it can occur without any signs or symptoms. Called “asymptomatic stenosis,” it predisposes the patient to have a stroke. Asymptomatic stenosis is sometimes discovered during a routine examination, when the doctor listens to the carotid artery with a stethoscope and hears a "bruit" (a swishing sound), which is caused by artherosclerosis in the artery. In some cases, the first sign of carotid artery disease may be a stroke or a mini stroke (TIA).

Symptoms of a stroke or TIA may include:

Numbness or weakness in the arms or legs, especially on one side of the body
Drooping of one side of the face
Difficulty seeing from either one or both eyes
Slurred speech or difficulty communicating with others
Confusion
Sudden episode of memory loss
Disorientation or disturbance in coordination
Severe headache

Risk factors for carotid stenosis include:

Family history of atherosclerotic vascular disease
High blood pressure
High cholesterol
Heart disease
Diabetes
Smoking
Obesity
Inactive lifestyle

How Carotid Artery Disease is Diagnosed

Carotid artery disease is often diagnosed after you’ve experienced symptoms of a stroke. Your doctor may check for a blockage in the carotid arteries. Several tests are used to diagnose carotid artery disease, including:

Carotid duplex ultrasound
Cerebral angiogram
Magnetic Resonance Angiogram (MRA)
CT scan or CTA

How We Treat Carotid Artery Disease

The main goal of treatment for carotid artery disease is to prevent strokes and halt the progression of the atherosclerotic disease. Our team of highly trained and experienced vascular specialists determine which approach is best for you.

Mild carotid artery disease

Mild carotid artery disease can be treated with medications and lifestyle modifications that include a healthy diet, exercise, and smoking cessation. Your doctor will monitor for progression to a more severe form.

Severe carotid artery disease

For more severe diseases, treatment may include minimally invasive procedures such as carotid stenting or transcarotid artery revascularization (TCAR), or an open surgical procedure called a carotid endarterectomy.

Carotid stenting

Carotid stenting is a minimally invasive procedure in which a stent is inserted via a catheter through the femoral artery in the groin or the radial artery in the wrist and threaded to the carotid artery. The stent is then placed at the area of the blockage and deployed. The stent is left permanently in the artery to provide a reinforced channel through which blood can flow.

Transcarotid artery revascularization (TCAR)

Transcarotid Artery Revascularization (TCAR) is a minimally invasive procedure that is performed through a small incision at your neckline, just above your clavicle. The surgeon places a tube directly into your carotid artery and connects it to a system that will direct blood flow away from your brain, to prevent any loose plaque from reaching your brain. Your blood will flow through the system and any material will be captured in a filter outside the body. Your filtered blood will then be returned through a second tube in your upper leg. A carotid stent is then placed to stabilize the plaque in your carotid arteries. After successful placement, flow reversal is turned off and blood flow resumes in its normal direction.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure for removing plaque from the carotid arteries to allow an unobstructed flow of blood to the brain. The surgeon first makes a small incision on the side of the neck to expose the artery. The affected area of the artery is clamped so that the surgeon does not disturb blood flow; sometimes a shunt is used to divert blood that generally flows down this pathway. The artery is then opened and a special instrument is used to remove plaque from the inside of it. The artery is then sutured closed. In some cases, the surgeon may widen that area of the artery with a synthetic graft.

Why Choose Us

NewYork-Presbyterian is a leader in the field of vascular medicine, with a long tradition of expertise, innovation, and leadership. Our vascular specialists have many years of experience in the treatment of carotid artery disease and carotid stenosis.

Individualized and holistic care

At NewYork-Presbyterian, our vascular specialist team offers individualized and holistic care, tailoring your treatment to your medical history, lifestyle, and wellness goals. We are especially skilled in diagnostic imaging, medical therapy, and minimally invasive procedures that allow for shorter and less painful recovery times. We provide the highest level of service from your initial visit through follow-up and recovery.

Multidisciplinary team approach

The vast network of doctors and specialists at NewYork-Presbyterian are here to help you achieve your best possible health and quality of life. Our vascular medicine team often works with other specialists, such as interventional radiologists, neurologists, cerebrovascular surgeons, and others to ensure that you receive comprehensive treatment to meet your unique needs.