Carotid artery disease consultation
A Mayo Clinic neurologist talks with a woman about her diagnosis.
Your doctor is likely to start with a thorough medical history and physical examination. The exam generally includes listening for a swooshing sound (bruit) over the carotid artery in your neck, a sound that's characteristic of a narrowed artery. Your doctor may then test your physical and mental capabilities such as strength, memory and speech.
After that, your doctor may recommend:
- Ultrasound, to assess blood flow and pressure in the carotid arteries.
- CT or MRI, to look for evidence of stroke or other abnormalities.
- CT angiography or MR angiography, which provides additional images of blood flow in the carotid arteries. A contrast dye is injected into a blood vessel, and a CT scan or an MRI gathers images of your neck and brain.
In carotid endarterectomy, your surgeon opens the carotid artery to remove atherosclerotic plaques.
In carotid angioplasty, a long, hollow tube (catheter) is threaded through the arteries to the narrowed carotid artery in the neck. A filter is inserted to catch any debris that may break off during the procedure. Then, a tiny balloon at the end of the catheter is inflated to open the narrowed area.
In carotid stenting, a long, hollow tube (catheter) is threaded through the arteries to the narrowed carotid artery in the neck. A metal mesh tube (stent) is inserted into the vessel to serve as a scaffold that helps prevent the artery from narrowing again. The catheter and the filter — which catches any debris that may break off during the procedure — are removed.
The goal in treating carotid artery disease is to prevent stroke. Specific treatments depend on the extent of blockage in your carotid arteries.
If blockage is mild to moderate, your doctor may recommend:
- Lifestyle changes to slow the progression of atherosclerosis. Recommendations may include quitting smoking, losing weight, eating healthy foods, reducing salt and exercising regularly.
- Medication to control blood pressure or lower cholesterol. Your doctor may also recommend taking a daily aspirin or other blood-thinning medication to prevent blood clots.
If blockage is severe, or if you've already had a TIA or stroke, your doctor may recommend removing the blockage from the artery. The options include:
- Carotid endarterectomy, the most common treatment for severe carotid artery disease. After making an incision along the front of your neck, the surgeon opens the affected carotid artery and removes the plaques. The artery is repaired with either stitches or a graft.
- Carotid angioplasty and stenting, if the blockage is too difficult to reach with carotid endarterectomy or you have other health conditions that make surgery too risky. You are given local anesthesia and a tiny balloon is threaded by catheter to the area of the clog. The balloon is inflated to widen the artery, and a small wire mesh coil (stent) is inserted to keep the artery from narrowing again.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Preparing for your appointment
You may be referred to a doctor who specializes in disorders of the brain and nervous system (neurologist).
What you can do
- Write down your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all your medications, vitamins and supplements.
- Write down your key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your doctor
- What's the most likely cause of my symptoms?
- What kinds of tests do I need?
- What kinds of treatments do I need?
- Should I make any lifestyle changes?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may make time to go over points you want to spend more time on. You may be asked:
- Have you had any stroke-like signs and symptoms, such as weakness on one side of your body, trouble speaking or sudden vision problems?
- When did you first begin experiencing symptoms? How long did they last?
- Do you smoke?
- How much alcohol do you drink?
- Do you exercise regularly?
- What do you eat in a typical day?
- Do you have a family history of heart disease or stroke?
- Do you have symptoms of sleep apnea?
- Have you been diagnosed with any other medical conditions?
Carotid artery disease care at Mayo Clinic
Oct. 04, 2018
- Furie KL. Pathophysiology of symptoms from carotid atherosclerosis. https://www.uptodate.com/contents/search. Accessed April 24, 2017.
- McCarron MO, et al. Screening for asymptomatic carotid artery stenosis. https://www.uptodate.com/contents/search. Accessed April 24, 2017.
- Daroff RB, et al. Ischemic cerebrovascular disease. In: Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. https://www.clinicalkey.com. Accessed April 24, 2017.
- Ferri FF. Carotid stenosis. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed April 24, 2017.
- Bope ET, et al. The cardiovascular system. In: Conn's Current Therapy 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed April 24, 2017.
- AskMayoExpert. What are the risk factors for carotid artery disease? Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Carotid artery disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/catd/. Accessed 24, 2017.
- Grotta JC. Carotid stenosis. New England Journal of Medicine. 2013;369:1144.
- Furie KL. Evaluation of c arotid artery stenosis. https://www.uptodate.com/contents/search. Accessed April 24, 2017.
- Mohler ER III, et al. Management of asymptomatic carotid atherosclerotic disease. https://www.uptodate.com/contents/search. Accessed April 24, 2017.
- Barrett KM (expert opinion). Mayo Clinic, Jacksonville, Fla. April 14, 2017.
- Morales-Volero SF, et al. Asymptomatic carotid artery stenosis: Time to rethink our therapeutic options? Neurosurgery Focus. 2014;36:E2.
- Babu MA, et al. The durability of carotid endarterectomy: Long-term results for restenosis and stroke. Neurosurgery. 2013;72:835.
- Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. March 30, 2017.
- Barrett KM, et al. Stroke: Advances in medical therapy and acute stroke intervention. Current Cardiology Reports. 2015;17:79.
- Huang Y, et al. IP085. Contemporary outcomes after carotid endarterectomy mandate revision of society guidelines to recommend new benchmarks for appropriate treatment of carotid artery disease. Journal of Vascular Surgery. 2016;63(suppl):84S.
- Huang JF, et al. Interventions for extracranial carotid artery stenosis: An update. Current Treatment Options in Cardiovascular Medicine. 2016;18:34.
- Krishna C (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. April 14, 2017.
- Malas M, et al. Effect of patching on reducing restenosis in the Carotid Revascularization Endarterectomy versus Stenting Trial. Stroke. 2015;46:757.
- Barrett KM, et al. Stroke caused by extracranial disease. Circulation Research. 2017;120:496.
- Brinkjiki W, et al. Ultrasound characteristics of symptomatic carotid plaques: A systematic review and meta-analysis. Cerebrovascular Diseases. 2015;40:165.