CAROTID DISEASE

Carotid Artery Disease Treatment

Preventing stroke through early detection and advanced endovascular intervention.

Understanding

Understanding Carotid Disease

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 visualization showing stenosis
Symptoms

Warning Signs of Carotid Disease

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.

Sudden weakness or numbness on one side of the face, arm, or leg
Trouble speaking or understanding speech
Sudden vision loss in one eye (amaurosis fugax) — often described as a "shade coming down"
Dizziness or loss of balance
Difficulty swallowing
Sudden severe headache with no known cause
Warning signs of carotid artery disease
Diagnosis

Screening & Diagnosis

Early detection of carotid artery disease can prevent stroke. Screening is recommended for individuals who are:

Age 55 or older
Current or former smokers
Diagnosed with diabetes
Have a family history of stroke or vascular disease
Have previously experienced a TIA or stroke
Have known heart or peripheral vascular disease

Diagnostic Tests

Several tests can evaluate carotid artery health:

Carotid Ultrasound
A non-invasive, painless test using sound waves to measure blood flow and detect plaque buildup. This is typically the first screening test.
CT Angiography (CTA)
A CT scan with contrast dye that provides detailed 3D images of the carotid arteries and identifies the degree of narrowing.
MR Angiography (MRA)
An MRI-based technique that visualizes blood vessels without radiation, useful for patients who cannot have CT contrast.
Cerebral Angiography
The gold standard for detailed vessel imaging — provides the highest resolution and real-time blood flow information. Often used when endovascular treatment is being planned.
Carotid artery imaging and diagnostic evaluation
Treatment

Treatment Options

CAS
Carotid Artery Stenting (CAS) — Preferred

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.

CE
Carotid Endarterectomy (CEA)

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.

TC
Transcarotid Artery Revascularization (TCAR)

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.

Carotid artery treatment options
What the Research Shows

The CREST-2 Trial: Stenting Now Has the Strongest Evidence

CREST-2 found stenting reduced stroke risk by 53% over medical therapy alone.
Endarterectomy showed no statistically significant benefit over medical therapy.

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.

CREST-2 trial publication in the New England Journal of Medicine, January 15, 2026
Minimally Invasive

Minimally Invasive Stenting

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.

Minimally invasive stenting procedure illustration
Frequently Asked Questions

Carotid disease questions, answered

Related Conditions

StrokeCarotid stenosis is a stroke causeCerebral AngiographyDefinitive diagnosticVascular DissectionRelated carotid pathology

Concerned about your carotid health?

Early evaluation and treatment can significantly reduce your stroke risk. Contact our team for a consultation.

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