Carotid arterial stenosis is a narrowing of the lumen of the carotid artery, usually by atheroma (a fatty lump or plaque causing atherosclerosis). Atheroma's may cause transient ischemic attacks (TIAs) and cerebrovascular accidents (CVAs) as it obstructs the bloodstream to the brain. It also has the potential to generate emboli (blood clots) that obstruct the cerebral arteries.
The narrowing can either be asymptomatic (causing no medical problems) or presents with sympotms such as TIAs and CVAs.
DIAGNOSIS
Carotid stenosis is usually diagnosed by ultrasound scan of the neck arteries. This is the first imaging option and usually used for follow up and observation as it involves no radiation and no contrast agents that may cause allergic reactions.
If there is doubt whether the narrowing is still patent (open to blood flow) and the patient is to be assessd for treatment, the next imaging option would either be computed tomography angiogram (CTA) or a magnetic resonance imaging angiogram (MRA).
CTA is usually used as it's more widely available and faster (takes only several minutes). However, it does involve significant X-ray radiation and the use of contrast agents which is usually iodinated, which can cause allergic reactions, even anaphylaxis and can also cause renal failure.
MRA takes much longer to complete, more costly and not yet as widely available.
TREATMENT
Options for treatment include:
- Conservative (antiplatelet drugs)
- Carotid endarterectomy (surgical removal of the atheroma)
- Carotid stenting
