Present as:
The carotid arteries are paired arteries on each side of the neck that supply blood to the brain and face. There are two carotid arteries on each side of the neck (the internal and external carotid arteries). The internal carotid artery supplies blood to the brain, and the external carotid artery supplies blood to the neck, face, and scalp. The vertebral arteries are another set of paired arteries that supply blood to the brain. These arteries travel to the brain in the back of the neck. Therefore, there are four arteries that supply blood to the brain: the right and left internal carotid arteries and the right and left vertebral arteries.

A stroke generally refers to irreversible damage in a portion of the brain due to a lack of adequate blood flow. If one of the carotid arteries supplying blood to the brain is occluded (blocked), that portion of the brain may be affected. Similarly, if the carotid arteries contain a significant amount of plaque (narrowing), small pieces of this plaque or newly formed blood clots can break free and become lodged in a small brain artery causing a stroke. The risk factors for carotid artery disease are the same as those for other conditions of arteriosclerosis. These include, but are not limited to, genetic predisposition, smoking, diabetes mellitus, hypercholesterolemia (high levels of cholesterol), obesity and diet.

Diagnosis
Most disease of the carotid artery is diagnosed with noninvasive means by Duplex Ultrasound examination. However, it is imperative that the technologist be very familiar with the appropriate methods to perform this test since slight differences in technique can produce vastly different (and inaccurate) results. Assurance that a laboratory is proficient in this type of study is documented by its achieving accreditation from the ICAVL, a national regulatory body responsible for assuring quality of Noninvasive Vascular Laboratory.

Most diseases of the carotid arteries are asymptomatic (silent; without symptoms). Often an abnormal sound heard with the stethoscope ( a bruit) will prompt a physician to order the carotid ultrasound study. It is possible for a person to have a transient ischemic attack (mini-stroke) that produces only temporary symptoms that last for less than 24 hours. These are usually symptoms of weakness of an arm or leg or slurred speech that resolves quickly. A stroke can also be a sign of carotid artery disease but not all strokes are due to diseases in these arteries.

Treatment Options:
The decision to treat narrowing of the carotid artery is not always straightforward. With that said, not all carotid artery disease requires treatment. The risks of the surgery (taking into account the particular surgeon's experience) must be weighed against the potential benefit of the surgery. The degree of narrowing in the carotid artery, and the presence or absence of symptoms, are some of the important factors to consider when deciding on a therapeutic approach.

When it comes to the treatment of carotid artery disease, there are two primary options: Carotid Angioplasty with Stent placement (CAS) and a surgical Carotid Endarterectomy (CEA). Both aim to reduce the degree of narrowing in the carotid artery thereby reducing the chance of stroke. CAS acts by compacting the plaque and keeping the artery open with a metal device called a stent. CEA accomplishes the task by removing the plaque completely from the artery and widening the artery with the use of a patch to reduce the chance of the artery renarrowing. The two techniques have their own proponents with sufficient evidence to support their method.