Diagnosis & Treatment of Carotid Artery Disease

How is Carotid Artery Disease Diagnosed?

During an examination for suspected carotid artery disease (and sometimes during a routine checkup) your doctor will listen to the blood flow in your neck using a stethoscope. If the carotid artery is narrowed, it may create a characteristic “whooshing” sound called a bruit (BROO-ee). Not all women with carotid artery disease have a bruit.

Your doctor will also review your medical history and any medications you are taking. If the doctor hears a carotid bruit, or if you are at high risk for stroke (see Evaluating Your Stroke Risk), she or he will order an imaging test to look at the carotid arteries.

The first imaging test used to diagnose carotid artery disease is usually a carotid duplex ultrasound. This fast, inexpensive test uses reflected sound waves—like those used to see the fetus during pregnancy—to create detailed images of the inside of the carotid arteries. Carotid duplex ultrasound can detect blood flow problems caused by fatty deposits on the walls of the arteries.

If the ultrasound does not provide enough information, your doctor may order additional imaging tests. These tests can help determine if you would benefit from a procedure to clear the carotid arteries to help prevent a stroke.

  • CT angiogram – uses X-rays and a computer to produce images of your carotid arteries. A special dye (injected into a vein in your arm) is used to highlight the arteries.
  • MR angiogram – a special form of MRI that uses radio waves and a large magnet to produce images of blood flow in the carotid artery and brain.
  • Contrast angiogram of the neck – the gold standard test for carotid artery disease. To perform the test, a long, thin tube called a catheter is inserted into an artery in your groin or arm and guided to the area to be studied. The catheter is used to inject a dye into the blood vessels of your head and neck, and the dye is filmed by an X-ray camera, producing a movie of your carotid arteries as the blood moves through them. Although this procedure is very safe, there are some risks because it involves the catheter entering the body.

How is Carotid Artery Disease treated?

The goal of carotid artery disease treatment is to reduce the risk of a stroke. The treatment you receive will depend on how severe the blockages in your arteries are, whether you are having symptoms, and your general health.

All women with carotid artery disease will need to make lifestyle changes to slow the progression of the blockage and lower your risk for stroke. These include:

  • Getting regular exercise (at least 30 minutes a day 5 or more days a week)
  • Eating a heart-healthy diet low in saturated fat and cholesterol
  • Controlling your weight
  • Quitting smoking

While lifestyle changes may be enough for some people, many women also need to take medication to get their risk factors under control:

  • Drugs to control high blood pressure
  • Statins to lower cholesterol and prevent a stroke
  • Drugs to control your blood sugar if you have diabetes
  • Aspirin or other blood thinning drugs to prevent blood clots

If your carotid disease is severe and putting you at high risk for stroke, or if you have already experienced symptoms such as a TIA or stroke, you may need to undergo a procedure to clear the carotid arteries and prevent future strokes:

Carotid endarterectomy is a surgical procedure that removes fatty deposits ( plaque) from the inside of the carotid arteries. It is the most frequently performed surgery to prevent stroke, performed 100,000 times each year (40% of them in women). It can be used to prevent a stroke or TIA in women who have carotid arteries narrowed by atherosclerosis. See Should I have a carotid endarterectomy to prevent a stroke?

Carotid stenting is a less invasive procedure to prevent stroke in women with carotid artery disease. Like angioplasty and stenting for coronary artery disease, the procedure uses a long, thin tube called a catheter that is inserted through an artery in your groin or arm and guided to the location of the blockage. A tiny wire mesh tube is expanded and left in the artery to prop it open and allow blood to flow freely.

carotid_artery_before_and_afterAngiogram image of a narrowed carotid artery (A) and the same artery after it was opened with a stent (B)

How can I prevent Carotid Artery Disease?

Many of the lifestyle changes recommended to prevent carotid artery disease from getting worse can also prevent the disease in women who have not developed it. You should work with your doctor to identify your risk factors and get them under control. You cannot control some risk factors, such as your age, family history, and race. However, there are steps you can take to address other risk factors for carotid artery disease:

  • If you have high blood pressure, take your blood pressure medicine as prescribed by your health care provider and check your blood pressure regularly.
  • Keep your weight under control and don’t overeat.
  • Eat a healthy diet low in saturated fat and rich in fruits, vegetables, and whole grains.
  • Get regular exercise (30 minutes a day at least 5 days a week)
  • If your cholesterol level is too high, talk to your health care provider about ways to lower it.
  • If you smoke, educate yourself and get the support you need to quit. There are medications, support groups, and programs to help you stop smoking. Your doctor can also help. Call 1-800-QUIT-NOW for more information.
  • If you have heart disease or diabetes, take good care of yourself. See your health care provider and take your medicine as prescribed.
  • Aspirin therapy may be able to help prevent blood clots that can cause a stroke, especially if you already have artery disease; check with your health care provider before starting a daily aspirin regimen.

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