carotid artery stenosis

The carotid arteries run up either side of the neck and are the brain's main supply lines. Carotid artery stenosis is a narrowing of these vessels, usually caused by atherosclerotic plaque, much like a partly clogged pipe feeding a critical part of the house. The concern is less the reduced flow itself than the debris.

Most strokes from carotid disease happen not because the narrowing slowly starves the brain, but because a fragment of plaque or a clot breaks off and travels downstream to block a brain artery. A temporary blockage produces a transient ischemic attack, a brief stroke-like warning that resolves; a lasting one causes a stroke. Many people with stenosis, however, have no symptoms at all.

It may be suspected when a clinician hears a bruit, a whooshing sound, over the neck artery, and is confirmed and graded by ultrasound or other imaging. Management always includes aggressive medical therapy to stabilize plaque and reduce stroke risk, with antiplatelet and lipid-lowering drugs and blood-pressure control. For selected patients with significant narrowing, a procedure to clear or stent the artery may further lower risk, weighed carefully against the procedure's own risks.