Carotid Artery Disease

Carotid Artery Disease

Carotid Stenosis and Carotid Occlusion

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Our team of vascular surgeons, interventional neurologists, and cardiologists identifies and treats carotid artery disease at every stage. We use a variety of tools, perform thorough examinations, and collect history on your risk and extent of disease. Many treatments are available, including lifestyle modifications, medications, and advanced surgical techniques. Our goal is to help you lower your risk for stroke and remain healthy.

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Early Diagnosis, Active Management Lower Stroke Risk

Carotid artery disease is when fatty deposits called plaque build up on the inner walls of your carotid arteries, two of the main blood vessels that carry blood to your brain. When your carotid arteries narrow, it’s known as carotid artery stenosis. When they become completely blocked, it’s known as carotid artery occlusion. 
Risk factors for carotid artery disease include:
  • Family history of carotid artery disease
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Tobacco use
If you or your doctor thinks you may have carotid artery disease, screening for it is recommended. The disease often has no symptoms; the first sign can be a mild or severe stroke
Our skilled team of vascular surgeons, cardiologists, and neurologists work with you to carefully evaluate your personal risk factors early on, so we can monitor your condition and determine the best treatment approach for you.
Our Locations
Duke Health offers locations throughout the Triangle. Find one near you.


We use a variety of advanced screening technologies to capture highly detailed images of your carotid arteries to determine if they are narrowed or blocked by plaque buildup.


A noninvasive test that uses sound waves to measure the speed of blood flow in arteries and creates high-quality images showing how well the blood flows through the carotid arteries.

CT Angiography (CTA)

After a contrast dye is injected into your arm, a CT scan produces highly detailed images of your blood vessels, bones, and surrounding soft tissues. This creates a "map" of your arteries and indicates areas that are narrowed, blocked, or damaged.

Magnetic Resonance Angiography (MRA)

After contrast dye is injected into your arm, powerful magnets and a computer create detailed images that better define the soft tissue of your brain and blood vessels.

Catheter-Based Arteriogram

An arteriogram helps better define your blood vessel anatomy and is sometimes used to further evaluate an area of concern found on CTA or MRA. This is performed in a radiology suite and requires an intravenous (IV) line to be placed in an artery in your leg or arm. X-rays are then taken as dye is injected directly into the artery of concern to get a very clear picture in real time.

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Noninvasive Treatments

Our providers will discuss with you how much narrowing you have in your carotid arteries, what your risk is for a stroke, and what treatment approach is best for you. We may recommend one or more of the following.


We often prescribe close monitoring and repeat imaging to watch for any worsening of your stenosis.

Lifestyle Changes

We help you make lasting changes that positively affect your health. 
  • Our cardiac prevention and rehabilitation program is designed to prevent your carotid artery stenosis from worsening and to lower your risk for stroke. We provide the tools you need, including medically supervised exercise programs, nutrition and weight loss counseling, and high blood pressure control.
  • Our comprehensive smoking cessation resources help you stop tobacco products. We have multiple providers, locations, and support groups to assist you during the difficult transition as you quit. 


Various medications may be prescribed to manage your risk factors. These may include medicines to: 
  • lower your cholesterol and stabilize the plaque
  • keep high blood pressure in check
  • reduce your risk for blood clots
We coordinate with your primary care providers and other providers to find the right regimen for you.

Procedures to Open Blocked Arteries

Our specialists have experience performing all of the various procedures available to treat carotid artery disease. These are typically performed if you are having symptoms and your carotid artery is more than 50 percent blocked, or if you are otherwise healthy and your carotid artery is more than 70 percent blocked.

Carotid Endarterectomy (CEA)

In CEA -- considered the “gold-standard” of carotid artery procedures -- a surgeon removes plaque from the carotid artery through an incision along your neck.  Our skilled vascular surgeons and neurosurgeons collaborate closely during these procedures to monitor your risk for stroke. Most patients go home the day after surgery

Carotid Angioplasty and Stenting (CAS)

In this minimally invasive procedure, the doctor inserts a catheter (a narrow, flexible tube) through a small incision and guides it to your carotid artery. A balloon at the tip of the catheter is inflated in the artery to open it, and a small mesh tube, or stent, is inserted to keep the artery open. The artery heals around the stent. Studies show this procedure is as safe and effective as carotid endarterectomy in people whose health risks may prevent them from having open surgery.

Transcarotid Artery Revascularization (TCAR)

TCAR is a hybrid procedure that involves a small incision at the base of the neck. The doctor uses a stroke-prevention device to reduce the risk for stroke while inserting a stent in the narrowed portion of the artery. TCAR is used in people who have higher health risks that may prevent them from having CEA.

Consistently Ranked Among the Nation’s Best Hospitals
In addition, Duke University Hospital is proud to be named the best hospital in North Carolina, and nationally ranked in 10 adult and 9 pediatric specialties by U.S. News & World Report for 2019–2020.

Why Choose Duke

Advanced Tools for Early, Accurate Diagnosis
We use the latest risk assessment methods and imaging technology to identify and evaluate your carotid artery disease at the earliest possible stage.

Nationally Recognized Surgical Expertise
Our surgeons perform hundreds of procedures to open blocked carotid arteries each year. As invited participants in a National Institutes of Health study of minimally invasive and surgical approaches to carotid artery disease, our surgical team underwent additional rigorous training and credentialing.

Coordinated Stroke Prevention and Care
Because carotid artery disease is a leading risk factor for stroke, you have access to our nationally recognized team of vascular surgeons, neurologists, and interventional cardiologists. They work with you to prevent stroke and treat it if one occurs.

Reviewed: 10/16/2018