Carotid Artery Disease: Serious Neck Blockage Effects

Carotid artery disease occurs when the carotid arteries (two blood vessels in your neck that carry blood to your brain) become blocked with plaque. This process, known as atherosclerosis, is more common in older adults than younger people. Many people with carotid artery disease don’t have any symptoms. If left untreated, having a neck artery blockage significantly increases your chance of having a stroke or ministroke. 

Learn more about carotid artery disease, including risks, causes, symptoms, treatment options, and more.

Screening to Diagnose Carotid Artery Disease

Since many people with carotid artery disease are asymptomatic (don't show symptoms), the condition usually is detected through ultrasound imaging. Your healthcare provider may recommend that you undergo screening for carotid artery stenosis if they hear a rushing sound caused by abnormal blood flow (known as a bruit) when they use a stethoscope to listen to the arteries in your neck. 

Screening also may be recommended in patients with known peripheral vascular disease, and in patients with long-standing smoking history.

Carotid Artery Stenosis

The two types of screenings for carotid artery disease are:

• Carotid duplex ultrasound, which measures the speed of the blood flow in your arteries and looks for blockages and blood clots
• Carotid intima media thickness ultrasound, which measures the thickness of your artery walls and screens for the buildup of plaque

Using the results from these tests, your healthcare provider may diagnose you with:

• Moderate carotid artery stenosis, typically defined as a 50% to 69% blockage
• Severe carotid artery stenosis, typically defined as a 70% to 99% blockage

If your neck arteries are less than 50% blocked, your condition may be due to the natural effects of the aging process.

Risks of Blocked Carotid Arteries

Your carotid arteries play an essential role in your overall physical health and well-being. Plaque buildup and blood clots in the carotid arteries can interfere with blood flow to the face, head, and brain. Carotid artery stenosis can also cause a stroke when plaque comes loose and travels to the brain. This is known as embolic disease.

Embolic disease can lead to a stroke, which happens when brain cells die due to a lack of blood supply. In fact, about 10% to 15% of all strokes are likely due to previously asymptomatic carotid artery disease. Strokes often cause brain damage, which may affect your mobility, speech, and/or cognitive abilities. They can also be fatal. 

Untreated carotid artery disease can also cause a transient ischemic attack (TIA), or ministroke. Ministrokes occur due to a brief, temporary lack of blood flow to the brain. They can lead to future strokes.

What Causes a Neck Artery Blockage?

Carotid arteries become blocked with plaque, a combination of cholesterol, fat, calcium, fibrin, waste products, and other substances that collect on artery walls. This happens through the process of atherosclerosis, also known as arteriosclerosis. This causes the arteries to harden, narrow, and thicken, making it harder for blood to flow to the rest of your body. 

Anyone can develop a neck artery blockage, but some factors make it more likely. Risk factors for carotid artery disease include: 

• Age over 50
• Having obesity
• Hypertension (high blood pressure)
• Eating a high-fat diet
• Hyperlipidemia (high cholesterol)
• A family history of carotid artery disease
• Smoking
• Excessive alcohol use

Effect on Life Expectancy

After being diagnosed with carotid artery disease, your prognosis will depend on a number of factors. These may include your age, any comorbid (coexisting) conditions you have, the percentage that your artery is blocked, whether you’ve had a stroke, and the treatment you select, among others.

Carotid Artery Disease Symptoms Before Stroke

Most people with carotid artery disease don’t have any symptoms or warning signs before a stroke or mini-stroke. More commonly, people are diagnosed after a stroke or a visit to a healthcare provider who thinks they may be at risk. 

However, some people may notice the following signs:

• Blurry vision
• Confusion
• Problems with balance 
• Mobility issues
• Dizziness
• Light-headedness

Emergency Carotid Artery Disease Symptoms

Signs of a stroke or mini-stroke due to carotid artery disease may include:

• Vision problems, such as loss of vision or the sensation of a curtain falling over your eye
• Slurred speech 
• Difficulty understanding others when they speak
• Disorientation
• Loss of balance
• Difficulty walking
• Sudden, severe headache
• Facial drooping, especially on only one side of the face
• Weakness or numbness in the arms or legs, often on only one side

Call 911 or go to the hospital and seek emergency medical assistance if you or someone you know experiences any of the above symptoms.

Can You Treat Carotid Artery Disease Without Surgery?

Your healthcare provider may not recommend surgery if you have mild or moderate carotid arterial stenosis. Instead, they may suggest that you manage your condition by:

• Taking anticoagulants (blood thinners), such as baby aspirin
• Following up with a healthcare provider to treat comorbid conditions, such as diabetes
• Taking medication to control your blood pressure 
• Taking statins to lower your cholesterol levels
• Monitoring your blood pressure at home
• Exercising consistently
• Making dietary changes, such as eating a high-fiber diet and plenty of fruits and vegetables
• Quitting smoking

When a Blocked Carotid Artery Requires Surgery

You may need surgery to correct a blocked carotid artery if you’ve had a TIA or stroke due to carotid arterial stenosis. Your healthcare provider may also recommend that you undergo surgery to treat severe carotid artery disease even if you don’t have symptoms. 

There are two different surgical procedures that can help to treat a blocked carotid artery. Both are typically performed by a vascular surgeon. They include:

• Carotid endarterectomy: This procedure involves removing built-up plaque deposits from your blocked arteries. It is done to improve blood flow and prevent future strokes.
• Carotid artery stenting: Carotid artery stenting, or angioplasty, involves opening up the carotid artery with a balloon and placing a tiny tube called a stent inside. This keeps the artery from narrowing further and decreases the risk of having a stroke in the future.
  

Ongoing Treatment and Monitoring

If you have been diagnosed with and/or treated for carotid artery disease, your healthcare provider (typically a neurologist or cardiologist) might recommend regular follow-ups to monitor your condition. This usually involves undergoing further imaging testing at least once to ensure the blockage hasn’t progressed. 

Some researchers recommend that patients who have undergone a carotid endarterectomy or carotid artery stenting continue to see their healthcare provider once a year for follow-up visits. People with additional risk factors, such as diabetes or high cholesterol may need to see their provider every six months. Your healthcare provider might also ask you to check your blood pressure at home.

Coping Through a Carotid Artery Disease Diagnosis

Getting a diagnosis of carotid artery disease or any other chronic condition can be challenging. Many people with carotid arterial stenosis develop anxiety or depression, possibly in part due to the stress associated with the condition. 

Here are a few ways to cope with your diagnosis and prioritize your mental and physical health:

• Joining a peer support group to find community and resources
• Managing stress by getting enough sleep, avoiding burnout at work, and taking part in activities you enjoy
• Exercising regularly
• Seeking psychotherapy for comorbid mental health concerns
• Practicing relaxation and mindfulness techniques, such as deep breathing exercises and meditation

Summary

Carotid artery disease occurs due to a blockage in the arteries in your neck that provide an ongoing supply of oxygenated blood to your brain. Often asymptomatic, this condition can significantly increase your risk of a stroke. 

Talk to a healthcare provider about undergoing diagnostic testing if you are at risk of developing carotid artery disease. If you notice any warning signs of a stroke, get emergency medical help immediately.