Carotid Artery Disease

Carotid Stenosis and Carotid Occlusion

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Our specialized vascular neurologists, vascular surgeons, and neurosurgeons identify and treat carotid artery disease at every stage. Because carotid disease is a leading risk factor for stroke, our goal is to help you lower your risk for stroke and remain healthy. We offer a variety of treatment options, including lifestyle modifications, medications, and advanced surgical techniques.

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About Carotid Artery Disease

Carotid artery disease is the buildup of fatty deposits (called plaque) on the inner walls of your carotid arteries, two of the main blood vessels that carry blood and oxygen to your brain. The plaque can cause your carotid arteries to become narrow, known as carotid artery stenosis, or become completely blocked, known as carotid artery occlusion. Small bits of unstable plaque can also break off and travel to the brain, causing stroke.

Carotid disease develops over time, and many people don’t know they have it. It might be discovered during testing for a separate medical condition, and you may not have any clinical symptoms at all. In that case, it’s important to monitor risk factors -- including family history of carotid artery disease, high cholesterol, high blood pressure, obesity, diabetes, and tobacco use -- and to seek treatment immediately if you experience sudden symptoms like numbness or weakness, trouble speaking or understanding, vision loss, dizziness or balance problems, or severe unexplained headache.

In other cases, carotid disease may go undiagnosed until it causes a stroke or TIA (transient ischemic attack, or mini-stroke); both require emergency care.

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Duke Health offers locations throughout the Triangle. Find one near you.

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Tests for Carotid Arteries

In addition to discussing your medical history and performing a thorough examination, 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.

Ultrasound

A noninvasive test that uses sound waves to measure the speed of blood flow in carotid arteries and creates high-quality images showing how well blood is flowing through the carotid arteries. This test takes 20 to 40 minutes and is painless.

CT Angiography (CTA)

After a contrast dye is injected into your body, a CT scan (which delivers a small amount of radiation) 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. This test usually lasts from 30 to 60 minutes. Apart from some discomfort during the injection, this test is virtually painless.

Magnetic Resonance Angiography (MRA)

After contrast dye is injected into your body, powerful magnets and a computer create detailed images that better define the soft tissue of your brain and blood vessels. This test usually lasts from 30-60 minutes. Apart from some discomfort during the injection, this test is virtually painless.

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 images. This is performed in a sterile radiology suite and requires a small catheter (a narrow, flexible tube) to be placed in an artery in your groin or wrist. Using X-ray guidance, the catheter is advanced to the neck vessels. Then dye is injected directly into the artery of interest, allowing a short video of your circulation to be recorded.

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Non-Surgical Treatments

Depending on how much narrowing you have in your carotid artery and your risk for stroke, our providers will recommend a treatment approach that is ideal for you. These non-surgical options are often used together.

Monitoring

We closely monitor you and repeat imaging tests periodically to watch for any worsening of your stenosis.

Lifestyle Changes

We help you make lasting changes that can help reduce and stabilize plaque.

We can connect you with the tools you need, including medically supervised exercise programs, nutrition and weight loss counseling, and blood pressure control, to prevent your carotid artery stenosis from worsening and to lower your risk for stroke.
Our comprehensive smoking cessation resources help you stop using tobacco products. We have multiple providers, locations, and support groups to help you quit.

Medication

Various effective medications are available to manage your risk factors, including those that:

Lower your cholesterol and stabilize plaque
Keep high blood pressure in check
Reduce your risk for blood clots
Control your blood sugar level

Surgical Procedures to Open Blocked Arteries

Surgical options may be recommended only if you are having symptoms and your carotid artery is more than 50 percent blocked. Not every person is a candidate for surgery; our experts can present the best options tailored to your circumstances.

Carotid Endarterectomy (CEA)

While you are sedated with general anesthesia, a surgeon makes an incision along your neck and removes plaque from your carotid artery. Our skilled vascular surgeons and neurosurgeons collaborate closely during these procedures to monitor your risk for stroke. The procedure itself takes place in a standard operating room and lasts about an hour or more. Many patients are able to return home the day after surgery.

Carotid Angioplasty and Stenting (CAS)

For this less-invasive procedure, a doctor inserts a catheter through a small incision, usually in your groin area, and guides it to your carotid artery. A balloon at the tip of the catheter is inflated to push plaque back against the artery walls. Then a small wire mesh tube, or stent, is inserted to support the artery and keep it open. Studies show this procedure is as safe and effective as CEA in people with certain health risks that may prevent them from having traditional surgery. This procedure happens in an angiography suite and is done using local anesthesia or conscious sedation. CAS usually takes an hour or longer and requires an overnight hospital stay.

Transcarotid Artery Revascularization (TCAR)

TCAR is a newer procedure where a small balloon and, later, a stent are inserted through a small incision in the neck. TCAR is used in people whose arteries are very twisted at the base of neck. This procedure is done using local anesthesia or conscious sedation, and it takes place in a special “hybrid” operating room. TCAR takes an hour or longer, and it typically requires an overnight hospital stay. Duke was recently named a TCAR Center of Excellence by the medical device company that developed TCAR.

Best Hospital for Neurology, Neurosurgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our neurology and neurosurgery program is nationally ranked, and the highest ranked program in North Carolina by U.S. News & World Report for 2020–2021.

Why Choose Duke

TCAR Center of Excellence
Duke was designated a Center of Excellence by TCAR developer Silk Road Medical. This classification recognizes that we use the TCAR procedure for the right patients, we have a well-trained and credentialed team, and we are committed to delivering high-quality care.

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 neurologists, vascular surgeons, and neurosurgeons who work together to prevent and treat stroke. Our surgeons perform hundreds of procedures to open blocked carotid arteries each year and are nationally recognized surgical experts.

Clinical Research Opportunities
Duke may have opportunities for you to participate in clinical trials studying new and better ways to treat carotid disease or associated risk factors. This could give you access to these novel treatments before they’re widely available. 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.

Reviewed: 05/20/2020