Diagnosis

Diagnosis usually starts with a medical history and physical exam. The exam generally includes listening for a swooshing sound, known as bruit, over the carotid artery in the neck. A narrowed artery causes the sound. The next step might be a test of physical and mental abilities such as strength, memory and speech.

Imaging tests

These might include:

  • Ultrasound. This looks at blood flow and pressure in the carotid arteries.
  • CT or MRI. These can show if there's been a stroke or other issues.
  • CT angiography or MR angiography. These give more information about blood flow in the carotid arteries. These scans make images of the neck and brain after a contrast dye is put into a blood vessel. The dye makes areas of the images stand out.

Treatment

The goal in treating carotid artery disease is to prevent stroke. Treatment depends on how blocked the carotid arteries are, whether the blockage is causing symptoms, and the age and other illnesses of the person who has the blockage.

Treatment for mild to moderate blockage might involve:

  • Lifestyle changes to slow the buildup of fatty deposits. These might include quitting smoking, losing weight, eating healthy foods, reducing salt and exercising regularly.
  • Medicines to control blood pressure or lower cholesterol. This might include taking a daily aspirin or other blood-thinning medicine to prevent blood clots.

For severe blockage or for people who've had a TIA or stroke, treatment might involve removing the blockage. The options include:

  • Carotid endarterectomy. This is the most common treatment for severe carotid artery disease. After cutting along the front of the neck, a surgeon opens the blocked carotid artery and removes the plaques. The surgeon uses stitches or a graft to repair the artery.

  • Carotid angioplasty and stenting. This treatment is for blockages too hard to reach with carotid endarterectomy or for people who have other health conditions that make surgery too risky. This involves a local numbing medicine, known as anesthesia.

    A surgeon uses a tube, known as a catheter, to send a tiny balloon to the area of the clog. The surgeon inflates the balloon to widen the artery. Then the surgeon puts in a small wire mesh coil, known as a stent, to keep the artery from narrowing again.

Preparing for your appointment

Your primary care provider might refer you to a health care provider who specializes in conditions of the brain and nervous system, known as a neurologist.

What you can do

Ask a friend or relative to go with you to your appointment to help you remember all the information you get.

Make a list of:

  • Your symptoms, and when they began.
  • All the medicines, vitamins and supplements you take, including doses.
  • Key medical information, including other conditions you have and family history of heart attack and stroke.
  • Questions to ask your health care provider.

Questions to ask your doctor

  • What's the most likely cause of my symptoms?
  • What tests do I need?
  • What treatments do I need?
  • What lifestyle changes do I need to make?

Ask all the questions you have.

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

  • Have you had any stroke-like signs and symptoms, such as weakness on one side of your body, trouble speaking or sudden vision problems?
  • Do you smoke?
  • How much alcohol do you drink?
  • Do you exercise regularly?
  • What do you eat in a typical day?
  • Do you have symptoms of sleep apnea?
By Mayo Clinic Staff