Five Things You Should Know Carotid Artery Stenosis
We asked M Health Fairview Vascular Neurosurgeon Ramachandra Tummala, MD, FRCS, FAANS, to tell us five things we should know about carotid artery stenosis and its link to stroke risk.

Health and Wellness

Five things you should know about carotid artery stenosis

Five things you should know about carotid artery stenosis, one of the leading risk factors for stroke.

  • July 18, 2021
  • By Staff Writer

Stroke is a leading cause of long-term disability in the United States, and one out of every six cardiovascular disease deaths is caused by stroke, according to the Centers for Disease Control and Prevention. An American is killed by a stroke about every three-and-a-half minutes, according to estimates published in 2021 by the American Heart Association/ American Stroke Association.

Carotid artery stenosis – also known as carotid artery disease – is one of the leading risk factors for stroke. 

We asked M Health Fairview Vascular Neurosurgeon Ramachandra Tummala, MD, FRCS, FAANS, to tell us five things we should know about carotid artery stenosis and its link to stroke risk.

Carotid stenosis occurs when plaque buildup begins blocking blood flow.

Stenosis is a medical term for narrowing of blood vessels in the body due to a buildup of inflammatory substances and cholesterol deposits—called plaque. Two carotid arteries in the neck carry most of the blood flow from the heart to the brain. When stenosis occurs in these arteries, it is known as carotid artery stenosis. 

Carotid artery stenosis can lead to a stroke.

People who have carotid artery stenosis are at increased risk for a stroke, which can lead to disability or death. Sometimes, strokes can be mild and recoverable. In other cases, strokes are very large and devastating.

Carotid stenosis can cause a stroke in two ways. Often, plaque lodged in the carotid arteries comes loose and goes downstream into the blood vessels in the brain, where it blocks blood flow. We call that an embolism. The other, less common cause is when the carotid artery blockage becomes so severe that it actually slows down the blood flow to the brain. 

Learn more about M Health Fairview’s stroke care.

Carotid artery stenosis can be a sign of a more significant problem.

If there is blockage in the carotid arteries, it’s likely that the patient has buildup in other arteries throughout the body, Tummala said. Certain risk factors, like high blood pressure, diabetes, smoking, obesity, an unhealthy diet and a sedentary lifestyle, can put patients at greater risk for carotid artery stenosis. These are called “modifiable risk factors” because they are factors a person can partially or completely control.

Other risk factors include age, family history, and genetics. These are known as nonmodifiable risk factors. In general, heart risk and stroke risk largely follow one another. Good heart health practices can help reduce carotid artery stenosis – and therefore stroke risk.

The older you are, the higher your risk.

Plaque buildup happens in every adult. But not all plaque buildup will restrict blood flow through blood vessels or cause an embolism. The older you are, the higher the risk for buildup is. Men are more likely to experience plaque buildup than women. 

There are two types of carotid artery stenosis: symptomatic and asymptomatic. Symptomatic carotid artery stenosis is more important because it is associated with a higher risk of stroke. Asymptomatic narrowing carries less stroke risk. Sometimes, the stenosis can be detected by a primary care provider before symptoms occur.

Some patients may experience stroke-like symptoms, such as with a transient ischemic attack (TIA, sometimes referred to as a ministroke). These symptoms can include:

  • Sudden numbness
  • Trouble speaking or seeing
  • Dizziness 
  • Weakness on one side of the body
  • Weakness on one side of the face
  • A severe headache.

People who experience these symptoms should contact their doctor right away, because up to 40 percent of people who go on to have an ischemic stroke report having TIA symptoms beforehand.

Treatment includes medical management or possibly surgery.

At M Health Fairview, treatment is individualized based on whether the person is having symptoms, how severe the stenosis is, how old the person is, and the person’s unique health history.

Based on those factors, there are three possible ways to manage the disease: 

  1. Medical management, which may involve positive lifestyle changes and other modifications to reduce risk. These modifications may include medications such as aspirin, blood pressure lowering medications, and cholesterol lowering agents.
  2. Surgery called carotid endarterectomy, which is a preventive surgery that removes plaque buildup from the inside of the carotid artery. This operation has been evaluated rigorously over the past 60 years and is very effective method to lower stroke risk in certain patients, especially those with symptomatic severe stenosis.
  3. Minimally invasive surgery called carotid stent placement, a less invasive procedure that involves the placement of a small, expandable stent in the carotid artery to improve blood flow. This has been studied rigorously for about 20 years and is effective in certain patients, especially those patients whose surgical risk is high for the endarterectomy.

Learn more about M Health Fairview’s cerebrovascular surgery capabilities.