Carotid Artery Disease

Carotid Artery Disease (CAD) is a condition where the carotid arteries — the two main arteries in the neck that supply blood to the front and middle part of the brain — become narrowed or blocked, usually due to atherosclerosis (plaque buildup).

It’s a major risk factor for stroke and transient ischemic attacks (TIAs).

🫀 What Happens in Carotid Artery Disease?

• Over time, cholesterol and other substances form plaques inside the artery walls.
• These plaques can:
• Narrow the artery, reducing blood flow to the brain.
• Plaque disruption, causing a clot to form and potentially block blood flow, leading to a stroke.

⚠️ Symptoms

Often asymptomatic until a TIA or stroke occurs.

When symptoms do appear:

• Transient Ischemic Attack (TIA) – “mini stroke” symptoms that resolve in <24 hrs:
• Sudden weakness/numbness (often one side)
• Difficulty speaking or understanding
• Vision changes
• Dizziness or loss of balance
• Stroke – same symptoms, but persistent and potentially permanent

🧪 Diagnosis

1. Carotid Doppler Ultrasound – non-invasive, first-line
2. CT angiography (CTA) or MR angiography (MRA)
3. Cerebral angiography – most accurate but invasive

📊 Severity (Based on % Narrowing)

🛠️ Treatment

💊 Medical Management (for all patients)

• Antiplatelets: aspirin or clopidogrel
• Statins: reduce plaque progression
• Blood pressure and diabetes control
• Lifestyle changes: smoking cessation, healthy diet, exercise

🚨 Surgical/Procedural Interventions

1. Carotid Endarterectomy (CEA)
• Surgical removal of plaque
2. Carotid Artery Stenting (CAS)
• Less invasive alternative
• Often used for high surgical risk patients

🧠 Who Needs Stenting or Surgery?

• Symptomatic with ≥50% narrowing → Consider Stenting or CEA
• Asymptomatic with ≥70% narrowing → Consider Stenting or CEA in select cases

🔁 Monitoring

• Regular ultrasounds for mild/moderate disease

Aggressive risk factor modification to slow progression