What Is Carotid Artery Disease?

The carotid arteries are located on either side of the neck and supply oxygen-rich blood to the brain.

Carotid artery disease usually develops when atherosclerotic plaque builds up within the artery wall. Over time, this can narrow the artery and affect blood flow. Plaque can also become unstable and contribute to the formation or release of blood clots, which may travel to the brain and cause a TIA or ischemic stroke.

The degree of narrowing and the characteristics of the plaque are important when assessing an individual's risk.

Symptoms of Carotid Artery Disease

Carotid artery disease often has no noticeable symptoms, particularly in its earlier stages.

Symptoms may occur when reduced blood flow or plaque-related clot formation affects the brain. These can include symptoms of a TIA or stroke, such as:

• Sudden weakness or numbness, particularly on one side of the body
• Sudden difficulty speaking or understanding speech
• Temporary or sudden loss of vision
• Facial drooping
• Sudden difficulty walking, dizziness or loss of coordination

These symptoms require urgent medical attention, even if they resolve.

Causes and Risk Factors

Carotid artery disease is most commonly associated with atherosclerosis and the gradual buildup of plaque in the arteries.

Risk factors include:

• Increasing age
• High blood pressure
• High cholesterol
• Diabetes
• Smoking
• Obesity
• Physical inactivity
• Family history of vascular disease, stroke, or CAD
• Previous TIA or stroke
• Other forms of cardiovascular or vascular disease

Managing these risk factors is an important part of reducing the risk of carotid disease and stroke.

How Is Carotid Artery Disease Diagnosed?

Assessment may begin with a review of symptoms, medical history and vascular risk factors.

Depending on the circumstances, investigations may include:

• Carotid duplex ultrasound to assess blood flow and identify narrowing
• CT angiography (CTA) to provide detailed images of the carotid and cerebral circulation
• MR angiography (MRA) to evaluate the blood vessels using MRI
• Cerebral angiography in selected patients when more detailed vascular imaging is required

These investigations help determine the location and severity of carotid narrowing and can contribute to assessment of future stroke risk

Carotid Artery Disease and Stroke Risk

The relationship between carotid artery disease and stroke is important, but not everyone with carotid narrowing will have a stroke or require an intervention.

Stroke risk depends on factors including the severity and location of the narrowing, whether the patient has experienced symptoms such as a TIA or minor stroke, plaque characteristics and other vascular risk factors. This is why treatment decisions should be based on a comprehensive assessment rather than the percentage of narrowing alone.

Does Carotid Artery Disease Always Require Treatment?

No. Some people with carotid artery disease can be managed with medical treatment, lifestyle changes and regular monitoring.

For selected patients, particularly those with significant narrowing and relevant symptoms or other features associated with increased stroke risk, an intervention may be considered.

The appropriate approach depends on the individual's symptoms, imaging findings, degree of stenosis, overall health and risk of future stroke.

Carotid Artery Disease Treatment

Treatment aims to reduce the risk of stroke and manage the underlying vascular disease. Depending on the individual patient, treatment may include:

• Medical management and control of vascular risk factors
• Antiplatelet or other medication where clinically appropriate
• Lifestyle modification
• Regular monitoring and follow-up
• Carotid artery stenting for selected patients
• Carotid endarterectomy in appropriate cases

How Is the Right Treatment Decided?

The decision to treat carotid artery disease is individualised.

A specialist may consider:

• Whether you have experienced a TIA or stroke
• Degree of carotid artery narrowing
• Location of the narrowing
• Plaque characteristics
• Findings on ultrasound or other imaging
• Other cardiovascular and vascular risk factors
• Previous treatment and response
• Overall health and procedural risk

For some patients, medical management may be appropriate. For others, carotid intervention may provide an additional option for reducing future stroke risk.

When Should I See a Specialist?

Specialist assessment may be appropriate if you:

• Have been diagnosed with carotid artery narrowing
• Have been told you have carotid artery stenosis
• Have experienced a TIA or minor stroke
• Have abnormal carotid ultrasound findings
• Have significant vascular risk factors and have been advised to undergo further assessment
• Have been recommended for carotid surgery or stenting and would like to understand your options

A specialist assessment can help bring together your symptoms, imaging and vascular risk factors to determine the most appropriate next step. CAD mainly affects those in older age groups however, the factors leading up to the disease can begin at a very young age. The first obvious symptom is usually a stroke, which is usually already too late to prevent lasting effects on quality of life. Carotid artery disease affects every patient differently. While some people benefit from medical therapy and ongoing monitoring, others may require carotid stenting or another intervention to reduce their stroke risk. 

Carotid Artery Disease Assessment in Singapore

If you have been diagnosed with carotid artery disease, carotid artery stenosis or an abnormal carotid ultrasound, specialist assessment can help determine the severity of the disease and your potential risk of future stroke.

At the Supreme Vascular and Interventional Clinic in Singapore, Dr. Manish Taneja provides specialist assessment for selected patients with carotid artery disease. Assessment may include reviewing your medical history, previous TIA or stroke symptoms, vascular risk factors and relevant ultrasound, CT or MR imaging.

Where appropriate, he can discuss whether continued medical management and monitoring or a minimally invasive treatment such as carotid artery stenting may be appropriate for your individual circumstances.

The aim is not simply to treat the narrowing, but to understand your overall stroke risk and determine the most appropriate approach for your long-term vascular health.

Frequently Asked Questions