Carotid Artery Stenosis

The carotid arteries are the main arteries that run up both sides of the neck and carry blood to the brain. Over time cholesterol plaque builds up in the vessel wall and narrows it. If a piece of plaque breaks off or the vessel becomes completely blocked, blood flow to the brain is interrupted and a stroke can occur. Carotid stenosis is an important cause of ischemic stroke.

The narrowing often causes no symptoms. As a temporary warning, symptoms such as sudden weakness of an arm or leg, speech difficulty or brief loss of vision in one eye (transient ischemic attack) can occur. Even if they pass quickly they need urgent assessment.

Smokers, people with diabetes, high blood pressure or high cholesterol, those with coronary artery disease or leg artery disease, older patients and those with a family history of stroke are at risk. In these people screening the neck arteries with carotid ultrasound can be recommended.

The first step is color Doppler ultrasound. CT angiography or MR angiography is performed to show the degree of narrowing and the features of the plaque. The decision is made jointly by the neurologist, vascular surgeon and interventional radiologist according to the degree of stenosis, whether there are symptoms, the patient's age and associated diseases.

In carotid stenting a thin catheter entering at the groin (sometimes the wrist) reaches the narrowed segment of the artery. A protective filter is placed beyond the narrowing to prevent debris from reaching the brain, then the artery is opened with a balloon and a stent is placed to keep it open. Because it is usually done under local anesthesia the patient stays awake and neurological status can be monitored throughout.

The alternative is carotid endarterectomy, in which plaque is removed surgically. Which of the two is chosen depends on the patient's anatomy and risk.

Publications in which the doctor is among the authors include diffusion-weighted MRI findings of distal embolization after vertebral artery stenting (2007), management of vertebral stenosis complicated by acute thrombus (2007) and an unusual complication of carotid stenting, spontaneous rectus sheath hematoma, with its endovascular management (2007).

After the procedure the patient is observed in hospital for about a day. Blood-thinning medication (dual antiplatelet therapy in most patients) is taken for a defined period to prevent stent occlusion; it is very important not to stop medication without consulting the doctor. Quitting smoking and keeping blood pressure, cholesterol and blood sugar under control reduce the risk of new narrowing. The stent is checked by ultrasound at regular intervals.

Risks include stroke or transient ischemic attack, access-site bleeding, drops in blood pressure and heart rate, contrast-related kidney effects and re-narrowing within the stent. The risk varies by patient and is discussed in detail before the procedure.

To reduce stroke risk, keep blood pressure, cholesterol and blood sugar under control, stop smoking, exercise regularly, reduce salt and saturated fat and take the medication advised by your doctor regularly. In people with carotid stenosis, medical therapy, stenting or endarterectomy are considered according to the degree of narrowing.

Sudden facial droop, weakness of an arm or leg, speech difficulty or sudden loss of vision can be signs of stroke; in that case time is critical and 112 should be called without waiting.

At the first consultation your complaints, medical history, medications (especially blood thinners and diabetes drugs), allergies and previous imaging and test results are reviewed together. Any previous stroke or transient ischemic attack, heart and vascular disease, blood thinners used and ultrasound-CT findings are reviewed. Please bring previous reports, films and CDs, your current medication list and any blood test results.

If needed, additional imaging or tests are requested. Whether the treatment is suitable, how the procedure will be done, the possible risks and the alternatives are explained in detail; your questions are answered and the procedure is planned after your consent is obtained.

Preparation instructions are given according to the type of procedure and the patient's condition. In general this involves fasting for a set time before the procedure, having tests that show kidney function and bleeding-clotting values and adjusting some medications as advised by the doctor. Always tell us if you are allergic to contrast material or medicines.

Having a relative with you on the day of the procedure is helpful for returning home after discharge.

Consultations and procedures are carried out in person at Ankara City Hospital, Neuro-orthopedics Building, Department of Radiology, Interventional Radiology Unit; online consultation is not offered. Appointments can be made on DoktorTakvimi via the Book button or by phone at 0850 333 0388. See the Contact page for the address and directions.