Carotid & Stroke Prevention
Carotid Disease
Specialist assessment and treatment of carotid artery narrowing, with individual care focused on reducing the risk of stroke.
Assessment, surveillance and carotid surgery
Carotid narrowing may be discovered after a TIA or stroke, or incidentally during vascular imaging. Management depends on symptoms, severity of narrowing and individual stroke risk.
Understanding Carotid Disease
What is carotid artery disease?
The carotid arteries are major blood vessels in the neck that supply blood to the brain. Carotid disease develops when fatty deposits, known as plaque, build up within the artery and cause it to narrow.
This narrowing is known as carotid stenosis. In some patients, material from the plaque can break away or encourage a blood clot to form and travel towards the brain.
This may temporarily interrupt the blood supply and cause a transient ischaemic attack, or may result in a stroke.
Carotid disease may be identified
- Following a transient ischaemic attack
- Following a stroke
- After sudden temporary loss of vision
- During investigation of neurological symptoms
- Incidentally on ultrasound or other imaging
- During assessment of wider vascular disease
Stroke Risk
How carotid disease can affect blood flow to the brain
The degree of narrowing is important, but the clinical significance also depends on whether the plaque has caused symptoms.
Plaque Builds Up
Atherosclerosis causes fatty material to accumulate within the carotid artery wall.
The Artery Narrows
As plaque increases, the opening within the carotid artery becomes progressively narrower.
Material May Break Away
Small particles or blood clots can travel from the carotid artery towards vessels supplying the brain or eye.
TIA or Stroke
Temporary blockage may cause a TIA, while persistent interruption of blood supply can cause a stroke.
Carotid narrowing itself often causes no day-to-day symptoms
The first sign may be a TIA or stroke. This is why sudden neurological symptoms should always be treated seriously, even if they disappear after a few minutes.
Possible TIA or Stroke Symptoms
Symptoms usually begin suddenly
Symptoms caused by reduced blood supply to the brain or eye may be temporary or persistent.
Diagnosis
Assessing the carotid arteries
Assessment considers whether neurological symptoms are likely to have arisen from the carotid artery, as well as the degree and location of any narrowing.
Imaging helps determine whether surveillance, medical management or an intervention should be considered.
Clinical Assessment
Review of neurological symptoms, previous TIA or stroke, medical history and cardiovascular risk factors.
Carotid Duplex Ultrasound
Ultrasound assesses blood flow and helps estimate the severity of carotid artery narrowing.
Further Imaging
CT angiography or other imaging may be required to define the anatomy more precisely when planning treatment.
Treatment
Treatment is tailored to individual stroke risk
Management depends on whether the narrowing has caused symptoms, its severity, the anatomy of the artery and the patient's overall health.
Stroke Risk Reduction
Medical treatment is an important part of carotid disease management and may include antiplatelet treatment, cholesterol management and treatment of other cardiovascular risk factors where clinically appropriate.
Carotid Endarterectomy
Carotid endarterectomy is an operation to remove atherosclerotic plaque from inside the carotid artery in order to reduce the risk of future stroke in appropriately selected patients.
Cardiovascular Health
Carotid disease is part of a wider vascular picture
Carotid stenosis is most commonly associated with atherosclerosis, which can affect arteries throughout the body.
Reducing cardiovascular risk therefore remains important whether or not carotid surgery is required.
Risk-factor management may include
- Stopping smoking
- Cholesterol management
- Blood pressure control
- Diabetes management
- Regular physical activity
- Maintaining a healthy weight
- Appropriate medication following assessment
Consultant-led assessment and carotid surgery
Mr Benaragama has specialist expertise in carotid artery disease and carotid endarterectomy, alongside an active clinical research interest in carotid disease.
Mr Shanka Benaragama
Specialist experience in carotid disease and stroke prevention
Mr Benaragama is a Consultant Vascular and Endovascular Surgeon at Royal Free London and University College London Hospitals.
His clinical practice includes the assessment and surgical management of carotid artery disease, and he serves as Deputy Lead for carotid disease within the North Central London Vascular Network.
He is also actively involved in clinical research relating to carotid disease and stroke prevention.
Stroke & TIA Warning Signs
Sudden neurological symptoms are an emergency
If you or someone else develops sudden facial weakness, arm weakness or numbness, speech difficulty or other symptoms suggesting a stroke or TIA, call 999 immediately.
Even if the symptoms disappear after a few minutes, urgent hospital assessment is still required. Do not wait for a routine private consultation.
Frequently Asked Questions
Carotid disease questions
What is carotid stenosis?
Carotid stenosis means narrowing of one or both carotid arteries, usually because of atherosclerotic plaque within the artery wall.
Does carotid disease cause neck pain?
Carotid stenosis usually does not cause typical neck pain. It may produce no symptoms until a TIA or stroke occurs, or it may be discovered incidentally during vascular imaging.
What is a carotid ultrasound?
A carotid duplex ultrasound uses sound waves to assess the carotid arteries and measure blood-flow patterns, helping estimate the degree of narrowing.
Does everyone with carotid narrowing need surgery?
No. Treatment depends on whether the disease has caused symptoms, the severity of narrowing, imaging findings and the patient's overall clinical circumstances. Some patients are treated with medical therapy and surveillance rather than surgery.
What is carotid endarterectomy?
Carotid endarterectomy is an operation in which plaque is removed from inside the carotid artery to improve the arterial channel and reduce future stroke risk in selected patients.
Can carotid disease be treated with a stent?
Carotid artery stenting is an endovascular option used in selected circumstances. The choice between medical treatment, endarterectomy and stenting depends on individual anatomy, symptoms and clinical risk.
What should I do if I have had a TIA?
A suspected TIA requires urgent medical assessment because it can be a warning sign of a subsequent stroke. If symptoms are happening now, call 999 immediately.
Carotid Disease Consultation
Request a specialist vascular consultation
If carotid narrowing has been identified on a scan, you have an established diagnosis or would like a specialist vascular opinion, please contact the practice by email.
Email to Request a Consultation → benaragama.admin@lips.org.uk