Carotid artery disease is something I see very often in my practice, and what worries me most is that many people do not realise they have it until it becomes serious.
The carotid arteries are the two major blood vessels on either side of your neck that carry blood to your brain. When plaque builds up inside these arteries, the space for blood to flow becomes narrower. If the narrowing becomes severe or a clot forms, it can lead to a stroke.
In India, the number of people developing carotid artery disease has increased because of lifestyle factors, uncontrolled diabetes, high blood pressure, and smoking.
The condition grows slowly and silently, so understanding the early signs and knowing when to seek medical help can make a huge difference.
Key Causes of Carotid Artery Disease
The most common reason carotid arteries become blocked is atherosclerosis, which simply means plaque deposits building up inside the artery. This plaque is made of cholesterol, fat, calcium, and inflammatory cells. Over time, the arteries become harder and narrower.
High blood pressure is another major cause because constant pressure weakens the artery walls. Diabetes makes the blood vessels more vulnerable to damage and increases the risk of clot formation. High cholesterol, especially when combined with a poor diet, speeds up plaque buildup.
Smoking remains one of the biggest culprits. Even a few cigarettes a day can damage the inner lining of blood vessels. A sedentary lifestyle, obesity, and a strong family history all add to the risk.
Early Signs and Symptoms of Carotid Artery Disease
Most patients do not feel anything in the early stages. There is no pain, no heaviness, nothing obvious. This is why the disease often goes unnoticed.
When symptoms do appear, they may come in short episodes that last only a few minutes.
These can include mild dizziness, brief difficulty speaking, momentary weakness in an arm or leg, or temporary vision loss in one eye. Many people ignore these symptoms, assuming they are due to stress or tiredness, but they are actually warning signs known as mini-strokes.
Symptoms of Carotid Artery Problems and Stroke
If the artery becomes critically narrowed or a blood clot suddenly blocks it, stroke symptoms may occur. These symptoms usually appear abruptly.
A person may feel the face drooping on one side, experience difficulty speaking, or be unable to lift an arm. Vision may suddenly become blurred, or one eye may go completely dark. Some people feel unsteady while walking or become confused without warning.
These are medical emergencies. The sooner treatment is given, the higher the chances of preventing permanent brain damage.
How Carotid Artery Disease Is Diagnosed
Diagnosing carotid disease is straightforward. The first step is usually a carotid Doppler ultrasound, a simple scan that shows how much the artery is blocked.
If more detailed information is needed, we may advise a CT angiography or an MR angiography.
These provide clear pictures of the artery and help us decide the best treatment plan. In certain cases where a procedure is being considered, we may use digital subtraction angiography, which provides the highest precision.
Carotid Artery Blockage Treatment Options
The treatment depends mainly on the severity of the blockage and the presence of symptoms.
For mild or moderate blockages, medicines and lifestyle changes are usually enough. These include blood thinners, cholesterol-lowering medicines, blood pressure control, and strict sugar management. Quitting smoking and adopting a healthier lifestyle also play a huge role.
When the blockage is more than seventy percent, or when the patient has experienced mini-strokes or mild stroke symptoms, we recommend an intervention. The most reliable treatment is carotid endarterectomy, a surgery in which the plaque is cleaned out from inside the artery. This significantly reduces the risk of future strokes.
Another option is carotid stenting. This is a minimally invasive procedure where a stent is placed inside the artery to keep it open. It is especially useful for patients who are not ideal candidates for open surgery.
Each patient is different, so the treatment plan is always personalised.
Choosing the Right Vascular Specialist
Carotid artery disease needs careful judgment. You want a specialist who regularly handles both surgical and minimally invasive treatments. Skill and experience directly affect patient outcomes, especially in stroke prevention. It is also important to choose a centre equipped with good imaging facilities and a trained vascular care team.
Living With Carotid Artery Disease
If you are diagnosed with carotid artery disease, the journey does not stop with treatment. Long-term care is essential.
Keeping blood pressure and sugar under control, maintaining healthy cholesterol levels, staying active, eating well, and avoiding smoking completely all make a big difference. Regular follow-up scans ensure the condition remains stable.
With the right care, people with carotid artery disease can live full and healthy lives.
Conclusion
Carotid artery disease is serious, but it is also one of the most preventable causes of stroke. Understanding how it develops, recognising early warning signs, and getting assessed at the right time can save lives.
As a vascular surgeon, I always encourage patients not to wait for symptoms but to get checked if they have risk factors. Early action truly changes the outcome.
Frequently Asked Questions
Surgery is usually advised when the blockage is seventy percent or more, or when symptoms like a mini-stroke have occurred.
Mild narrowing can improve with medicines and lifestyle changes, but more severe blockages typically need a procedure.
Plaque cannot be removed without an intervention, but medicines can stabilise it and prevent it from growing.
Headaches are not very common in carotid stenosis. More typical symptoms involve vision changes, speech difficulty, or weakness.
Carotid endarterectomy usually takes about one and a half to two hours, and most patients go home within a day or two.
Dr. Sumit Kapadia
MBBS, MS, MRCS, DNB-Fellow
