Carotid stenosis is the narrowing of the carotid artery in the neck. The narrowing is the result of the build-up of a plaque inside the carotid artery, typically where it branches in the neck into its two major divisions. The build-up of plaque is associated with several risk factors like smoking, hypertension, elevated cholesterol, diabetes and obesity.
The most serious consequence of carotid stenosis is a stroke. A stroke results either when the narrowing in the carotid artery reduces blood flow to the brain below critical levels or when small pieces of the plaque (called emboli) become detached, flow up into the brain and clog a major artery. There are approximately 750,000 strokes per year in the United States and more than 150,000 patients die because of the stroke. Stroke is the third leading cause of death after coronary artery disease and cancer. It is believed that approximately half of strokes are due to narrowing of and plaque from the carotid arteries.
Although we find many patients to have carotid stenosis after they have a stroke, many are found to have this problem before having a stroke. Often, we can hear turbulent flow over the carotid arteries when we listen with a stethoscope. We then diagnose the degree of carotid stenosis by one or more of three tests:
If the tests reveal a critical stenosis of the carotid artery, we recommend treatment. When patients present with either a stroke or a transient ischemic attack (TIA or mini-stroke), we assess the degree of carotid stenosis and recommend treatment if we find critical stenosis.
Treatment of carotid stenosis at Johns Hopkins has traditionally been a collaborative effort between neurologists, neurosurgeons, vascular surgeons and interventional radiologists. If a surgical approach is decided upon, we treat perform one of two procedures:
Attributed to johnshopkins.org