In some patients, carotid stenosis can increase the risk of stroke. However, not every stenosis requires an intervention. The decision to treat depends on several factors, such as the degree of narrowing, the presence of symptoms, the characteristics of the plaque and the patient’s general health.
At Berkelium Vascular we study each case individually to determine vascular risk and establish the most suitable strategy: medical treatment and monitoring, carotid surgery or endovascular treatment.
What causes carotid stenosis?
The most common cause is atherosclerosis, a process in which fat, cholesterol and other substances build up in the artery walls.
Several factors can contribute to the development and progression of vascular disease:
- Age
- Smoking
- High blood pressure
- High cholesterol
- Diabetes
- Obesity
- Physical inactivity
- History of cardiovascular disease
- History of stroke or TIA
- Family history of vascular disease
Is carotid stenosis dangerous?
Many people with carotid stenosis have no symptoms, and the diagnosis is made during a vascular examination or an imaging test.
When symptoms do appear, there may be temporary or permanent neurological episodes, such as:
- Sudden loss of strength or sensation on one side of the body
- Difficulty speaking or understanding language
- Sudden loss of vision, especially in one eye
- Sudden problems with coordination or balance
- Drooping of one side of the mouth
These symptoms may indicate a transient ischaemic attack (TIA) or a stroke and require urgent medical assessment.
Diagnosis of carotid stenosis
Diagnosis begins with a clinical assessment and a vascular examination.
The most widely used initial test is carotid Doppler ultrasound, although in some patients other imaging techniques may be needed to understand the anatomy of the arteries more precisely.
Carotid Doppler ultrasound
Doppler ultrasound is a non-invasive test that makes it possible to study the carotid arteries and analyse both their structure and blood flow.
It is especially useful for the initial diagnosis and for monitoring patients with carotid disease.
CT angiography and other imaging tests
In some patients a CT angiography or MR angiography may be needed to complete the study. These tests provide more detailed images of the arteries and can be especially important when an intervention is being considered.
When does carotid stenosis need treatment?
In patients without symptoms, medical treatment, risk-factor control and a programme of monitoring with imaging tests may be indicated.
In certain more severe stenoses, especially when there is a recent history of neurological symptoms attributable to the affected carotid artery, an intervention may be indicated to reduce the risk of future episodes.
Medical treatment and vascular prevention
Medical treatment is essential both in patients with carotid stenosis and in those who have been treated with surgery or endovascular techniques.
The aim is to reduce the risk of atherosclerosis progressing and to prevent new cardiovascular or cerebrovascular events.
Depending on each patient’s characteristics, it may include:
- Good blood pressure control
- Cholesterol control
- Diabetes management
- Stopping smoking
- A healthy diet
- Regular physical activity
- Weight control
- Antiplatelet therapy or other medication when indicated
- Regular medical follow-up
Surgical treatment
Carotid endarterectomy
This is a surgical procedure to remove the atherosclerotic plaque that is narrowing the carotid artery.
During the procedure the carotid artery is accessed and the affected segment is opened to remove the plaque causing the stenosis. The artery is then reconstructed to restore proper blood flow.
It is a technique with extensive clinical experience behind it and remains one of the main treatment options for certain patients with significant carotid stenosis.
Endovascular carotid treatment
Endovascular treatment makes it possible to treat certain carotid stenoses with minimally invasive techniques.
In these procedures a catheter is introduced through an artery, usually from the groin or through arterial access at another site, and advanced to the affected area.
In selected patients a carotid stent can be placed to keep the artery open and improve blood flow.
Endovascular treatment can be a particularly useful alternative in certain patients for whom conventional surgery carries a higher risk, or when anatomical features make an endovascular strategy preferable.
Carotid surgery and stroke prevention
The main goal of treating carotid stenosis is not just to improve blood flow through the artery, but to reduce the risk of stroke.
For some patients, the best strategy will be appropriate medical treatment and regular check-ups. For others, especially when there is significant stenosis associated with certain symptoms, an intervention may be advisable.
When should you see a vascular surgeon?
A specialist assessment is advisable if you have been diagnosed with carotid stenosis or if an imaging test has detected an abnormality in your carotid arteries.
It may also be worth seeking advice if you have a history of TIA or stroke, arterial disease in other territories or multiple cardiovascular risk factors.
At Berkelium Surgical Group we study each case individually, assessing the severity of carotid disease, neurological history, risk factors, vascular anatomy and the patient’s general health.
Our goal is to offer a personalised strategy to reduce the risk of stroke and to clearly explain the different treatment alternatives, their benefits, their risks and the follow-up required.