Carotid stenosis

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

More about the experts All content is checked by medical journalists.

Carotid stenosis is the narrowing of the carotid artery. It mainly occurs in old age. The narrowing of the carotid artery can remain asymptomatic, but it can also lead to a stroke. In some cases, the patients need surgery. Read everything you need to know about carotid stenosis here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. I63I64I61I69I65

Carotid stenosis: description

Carotid stenosis is a narrowing (stenosis) of the carotid artery. There is a right and a left common carotid artery (common carotid artery) that run along the sides of the neck from the chest towards the head. They are divided into an inner and an outer carotid artery about halfway up the neck (internal and external carotid arteries). The internal carotid artery (ACI) primarily supplies blood to the brain, while the external carotid artery (ACE) primarily supplies blood to the scalp, face and upper neck organs. Carotid stenosis is usually in the area of the fork.

Carotid stenosis: frequency

The incidence of carotid stenosis increases with the age of the patient. For example, only about 0.2 percent of men under 50 have at least half their carotid artery narrowed. In over 60-year-olds, up to two percent and in over 80-year-olds a good seven percent have such asymptomatic carotid stenosis. Compared to women, men are affected roughly twice as often.

Carotid stenosis: symptoms

Carotid stenosis often causes no symptoms for a long time. Doctors then speak of asymptomatic carotid stenosis. If complaints occur, they can be different. Example:

Visual disturbances such as double vision or visual field loss
Speech disorders
Symptoms of paralysis in the arms and legs
headache
Attacks of dizziness

These carotid stenosis symptoms can appear like attacks and persist for minutes to hours. If they recede, one also speaks of a transitory ischemic attack (TIA), i.e. a temporary insufficient blood supply to the brain. If the symptoms persist for a long time or even increase, it is a stroke (apoplexy, insult).

Carotid stenosis: causes and risk factors

The most common reason for carotid stenosis is vascular calcification (arteriosclerosis). With increasing age, deposits (plaques) form on the inner vessel walls - including the carotid artery. These deposits narrow the vessel. Risk factors such as smoking, high blood pressure or increased blood lipids speed up the process. Small pieces of the plaques can eventually tear off, enter the brain vessels with the bloodstream and narrow or completely block one of them. The result is reduced or no blood flow to the brain tissue (ischemia). If the downstream brain tissue is not quickly supplied with sufficient oxygen again, it dies - an ischemic stroke (cerebral infarction) has occurred.

Carotid stenosis: risk factors

Various risk factors contribute to the narrowing of the carotid artery. These are among others:

Age and gender
High blood pressure (arterial hypertension)
Increased blood lipids (hyperlipidemia)
Diabetes mellitus
smoking
Obesity

Accordingly, lifestyle has a major influence on the development of carotid stenosis. Those who eat healthily, exercise enough and do not smoke are likely to develop carotid stenosis less often, or at least later, than those who lead an unhealthy lifestyle.

Carotid stenosis: examinations and diagnosis

Carotid stenosis is usually noticed in an ultrasound examination, but in some cases also through typical symptoms. The first point of contact is usually your family doctor, who may refer you to a neurologist. A doctor will first ask you in detail about your medical history (anamnesis). Possible questions are, for example:

Do you have high blood pressure or diabetes?
Do you smoke?
Do you have any problems with your vision every now and then?

Carotid stenosis: physical examination

The doctor will then examine you. He feels the pulse on his neck and wrists. If there is a carotid stenosis in the section of the common carotid artery, the pulse may be difficult to feel. Then the doctor will listen to your heart and large vessels with the stethoscope. With carotid stenosis, flow noises may be heard over the carotid arteries.

Carotid stenosis: laboratory tests

The doctor will draw blood from you so that it can be examined in the laboratory for blood lipid levels, sugar levels and coagulation values.

Carotid stenosis: apparatus investigations

The ultrasound examination (sonography) in particular is helpful in diagnosing carotid stenosis - more precisely, a special form of ultrasound: duplex sonography. With their help, both the blood flow in the vessels and the vessels themselves can be displayed. In this way, the severity of the stenosis can be determined and the type of narrowing recognized. If the deposits on the vessel wall are rather firm and compact, the likelihood that they will peel off is lower than with brittle and uneven deposits.

Doctors often do more tests to better assess the risk of stroke. This includes, for example, the ultrasound examination of the heart. The doctor can determine whether clots have formed in the heart that are threatening to be washed into the carotid arteries and displace them.

Furthermore, a long-term electrocardiogram (long-term ECG) is carried out in order to find possible indications of cardiac arrhythmias. This increases the risk of clots forming in the heart, which can obstruct the carotid arteries.

In order to be able to visualize possible vascular constrictions in other vessels that supply the brain, neurologists often supplement a transcranial Doppler sonography. The flow velocities in the cerebral vessels that run in the skull are recorded with an ultrasound device.

Angiography may also be done. In this vascular display, contrast agent is injected into the patient and the patient's head is X-rayed. The blood vessels fill with contrast medium, which makes possible constrictions visible. Sometimes computed tomography (CT) or magnetic resonance imaging (MRI) are used for this.

Carotid stenosis: treatment

The aim of treating carotid stenosis is to prevent a stroke and ensure blood supply to the brain. To do this, it is important to first minimize the risk factors. As a patient, you can make a significant contribution to this: Get used to a healthy lifestyle with sufficient exercise, a balanced diet and avoidance of nicotine. Furthermore, your blood pressure and blood sugar should be optimally adjusted. A healthy lifestyle helps here too. If necessary, your family doctor will also prescribe medication (antihypertensive, antihypertensive).

To minimize the risk of a stroke, the doctor may also prescribe "blood-thinning" tablets for you. These so-called platelet aggregation inhibitors (such as acetylsalicylic acid = ASA) prevent blood clots (thrombi) from forming and clogging the blood vessels.

Carotid stenosis: surgical treatment

Surgery may be indicated in patients who have already suffered a stroke due to carotid stenosis or who are at high risk of stroke (for example due to very narrow blood vessels or very high blood lipids). In the so-called thrombendarterectomy (TEA, also CEA = Carotid Thrombendarterectomy), the constriction is removed under general or regional anesthesia: the surgeon exposes the affected area of the carotid artery through an incision and cuts it open. He removes the deposits on the vessel wall and then sews the vessel shut again. The operation takes about an hour.

There is a risk that the operation itself will cause a stroke. Therefore, the procedure should only be performed in medical centers that have sufficient experience with TEA. In addition, the attending physicians carefully weigh the benefits and risks of the operation. Life expectancy, the degree of stenosis and any previous illnesses play a role.

Another procedure that is used for carotid stenosis is the so-called carotid angioplasty with stent insertion. The affected vessel is expanded from the inside with a balloon catheter and a vascular support (stent) is inserted, which expands on its own.

Carotid stenosis: disease course and prognosis

Carotid stenosis can go undetected for a long time and cause no symptoms. This is dangerous because the narrowing of the carotid artery usually increases over time, which increases the risk of stroke. Every year about 2 out of 100 asymptomatic carotid stenoses that are discovered by chance cause a stroke. In addition, patients with carotid stenosis are at increased risk of having a heart attack.

Therefore, talk to your doctor in detail about treatment options. Changing lifestyle with enough exercise and healthy eating can improve the prognosis of carotid stenosis.

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