Carotid Stenosis

What is carotid stenosis?

Carotid stenosis is the narrowing of the carotid artery in the neck. The narrowing is the result of the buildup of plaque inside the carotid artery, typically where it branches in the neck into its two major divisions. The buildup 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.

Diagnosis of carotid stenosis

Carotid stenosis can be discovered after someone has a stroke, but a patient may also be found to have this problem before a stroke occurs. Often, the doctor can hear turbulent flow over the carotid arteries when listening with a stethoscope. The cerebrovascular team then diagnoses the degree of carotid stenosis by one or more of four tests:

• Duplex sonogram of the neck
• Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scan of the neck
• CT angiography (CTa) scan of the neck
• Angiogram or arteriogram of the carotid arteries

If the tests reveal a stenosis of the carotid artery, the cerebrovascular team will consider medical versus surgical 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 may recommend medical versus surgical treatment depending upon the severity of the carotid disease.

Treatment for carotid stenosis

Treatment of carotid stenosis at Johns Hopkins has traditionally been a collaborative effort between neurologists, neurosurgeons, vascular surgeons and interventional radiologists. Johns Hopkins has among the best results in the country for surgery for carotid stenosis, with a published rate of 0.8% mortality and 1.8% morbidity. If you and your team agree that a surgical approach is best for you, we may recommend one of two procedures:

• Microsurgical carotid endarterectomy: This is the treatment of choice for most patients with serious carotid stenosis. During this procedure, we remove the plaque from the inside of the carotid artery and re-establish uninterrupted blood flow to the brain.
• Endovascular angioplasty and stenting: This procedure may be recommended for those who cannot undergo surgery. During this procedure, the cerebrovascular team introduces a balloon into the inside of the carotid artery, displaces the plaque, and places a stent to reinforce the walls.

For more information, contact the Johns Hopkins Cerebrovascular Center at 410-955-2228.

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