The carotid arteries are the two large blood vessels on either side of the neck that deliver oxygen-rich blood to the brain. Over time, plaque — a buildup of cholesterol, fat, and other substances — can accumulate in the artery walls, causing the vessel to narrow. This condition is called carotid artery disease, or carotid stenosis.
When the carotid arteries become significantly narrowed, the risk of stroke increases substantially. Pieces of plaque can break loose and travel to the brain, or the narrowed artery may block blood flow entirely. Carotid artery disease is one of the most common and treatable causes of stroke.
Vertebral artery disease follows a similar pattern in the vertebral arteries, which supply blood to the back of the brain. Both conditions require careful evaluation and, in many cases, intervention to reduce stroke risk.

Carotid artery disease often causes no symptoms at all until it leads to a stroke or transient ischemic attack (TIA). That is why screening is so important for at-risk individuals.
TIA Warning Signs — Seek Immediate Evaluation
A transient ischemic attack (TIA or "mini-stroke") produces stroke-like symptoms that resolve within minutes to hours. A TIA is a warning sign that a major stroke may follow — it should never be ignored.

Early detection of carotid artery disease can prevent stroke. Screening is recommended for individuals who are:
Diagnostic Tests
Several tests can evaluate carotid artery health:

Carotid artery stenting is a minimally invasive procedure that opens a narrowed carotid artery and places a small wire mesh tube (stent) to hold the artery open. A catheter is threaded through a blood vessel in the groin or wrist to the carotid artery, where a balloon angioplasty is performed first to widen the narrowed segment, and then the stent is deployed.
CAS avoids the need for open neck surgery, has a shorter recovery period, and is especially effective for patients at higher surgical risk. The CREST-2 trial confirmed stenting significantly reduces stroke risk in high-grade asymptomatic stenosis.
CEA is the traditional open surgical approach. It requires a neck incision to physically remove the plaque. The CREST-2 trial found that endarterectomy did not provide a statistically significant benefit over intensive medical therapy alone in asymptomatic high-grade stenosis.
A hybrid approach that combines direct carotid access through a small neck incision with a temporary blood flow reversal system. Available in select cases when transfemoral stenting is not ideal.

Published in the New England Journal of Medicine on January 15, 2026, CREST-2 was a pair of parallel randomized trials across 155 centers and 2,485 patients with high-grade asymptomatic carotid stenosis. Stenting was the only revascularization strategy shown to significantly reduce stroke compared with intensive medical therapy alone (P=0.02). Endarterectomy did not (P=0.24).
Source: Brott TG, et al. N Engl J Med 2026;394:219-231. DOI: 10.1056/NEJMoa2508800.

Carotid artery stenting is performed through a small catheter-based access — typically through the groin or wrist — avoiding the need for open surgery. This minimally invasive approach offers faster recovery, smaller incisions, and reduced complication rates for appropriately selected patients.
Our endovascular specialists use advanced imaging and real-time guidance to precisely place stents, ensuring optimal blood flow restoration and long-term stroke prevention.
