Carotid artery disease affects the major blood vessels in the neck that supply oxygen-rich blood to the brain. It occurs when the arteries become narrowed or blocked due to plaque buildup. A sticky substance composed of cholesterol, fatty deposits, calcium and cellular waste found in the blood, plaque can gradually accumulate inside the arteries, causing the arterial walls to harden and narrow (atherosclerosis).
Commonly referred to as “hardening of the arteries,” atherosclerosis can make it more difficult for the heart to pump blood, restricting circulation to vital organs and tissues. Hardening of the carotid arteries can compromise the oxygen supply to the brain, potentially contributing to cognitive decline and other neurological issues. Additionally, plaque can rupture and form blood clots, which can break away from the arterial walls and travel to the brain, causing a life-threatening stroke.
Carotid artery disease is relatively common, particularly among older adults. Given its potential severity, early identification and management are essential to preserving overall cardiovascular and neurological health. Because atherosclerosis often develops slowly and may not produce noticeable symptoms in its early stages, the condition sometimes goes undetected until it causes a stroke or transient ischemic attack (TIA). This underscores the importance of understanding atherosclerosis and carotid artery disease and their potential health effects.
What Are the Types of Carotid Artery Disease?
Carotid artery disease most commonly results from atherosclerosis, a condition in which plaque gradually builds up within the carotid arteries. Atherosclerotic carotid artery disease may lead to:
• Carotid artery stenosis (narrowing) - Due to plaque accumulation, the carotid arteries can become significantly narrowed, which can increase the risk of stroke if blood flow to the brain is severely restricted or a clot forms.
• Carotid artery occlusion (complete blockage) - In advanced cases, a carotid artery may become completely blocked due to advanced atherosclerosis or a blood clot. This can lead to a stroke if collateral circulation does not compensate for the blockage.
Other non-atherosclerotic disorders that can affect the carotid arteries include carotid artery dissection and fibromuscular dysplasia (FMD), both of which can reduce blood flow to the brain and increase the risk of stroke.
What Causes Carotid Artery Disease and What Are the Risk Factors?
Carotid artery disease is primarily caused by atherosclerosis. Factors that can influence its development include:
• Diabetes – Elevated blood sugar levels can contribute to arterial damage and accelerate the progression of atherosclerosis.
• High blood pressure (hypertension) – Increased pressure within the arteries can damage the arterial walls, making them more susceptible to plaque buildup.
• Inflammation – Rheumatoid arthritis and other chronic inflammatory conditions can lead to vascular damage and plaque formation.
Risk factors for carotid artery disease include:
• Advanced age – Because the arteries naturally lose elasticity and accumulate plaque over time, the risk of carotid artery disease increases with age.
• Gender – Men tend to develop carotid artery disease at an earlier age than women, although the risk in women increases after menopause.
• Genetic predisposition – A family history of atherosclerosis, heart disease or stroke can increase the risk of carotid artery disease.
• High cholesterol – Elevated levels of low-density lipoprotein (LDL or “bad”) cholesterol and reduced levels of high-density lipoprotein (HDL or “good”) cholesterol can contribute to plaque formation.
• Obesity – Excess body weight is linked to hypertension, high cholesterol and diabetes, all of which increase the risk of carotid artery disease.
• Poor nutrition – A diet high in saturated fats, trans fats and/or processed sugars can contribute to plaque buildup in the arteries.
• Sedentary lifestyle – Lack of physical activity is associated with poor blood circulation, hypertension and obesity.
• Sleep apnea – Repeated drops in oxygen levels during sleep can contribute to vascular damage and increase cardiovascular risk.
• Tobacco use – Smoking can damage blood vessels, accelerate plaque buildup and increase the likelihood of blood clot formation.
What Are the Warning Signs and Symptoms of Carotid Artery Disease?
Carotid artery disease often develops silently, producing no warning signs until the condition has significantly progressed. Sometimes, it is detected during a routine physical examination. When listening to the carotid arteries with a stethoscope applied to the neck, the physician may hear an abnormal swooshing sound (bruit), a hallmark sign of arterial blockage.
As the narrowing worsens and restricts blood flow to the brain, symptoms may begin to emerge, such as:
Transient Ischemic Attack
A TIA, also known as a “mini-stroke,” occurs when blood flow to the brain is temporarily reduced due to a partial blockage in a carotid artery. Though brief, this episode can serve as a critical warning sign of an impending stroke. TIA symptoms, which usually appear suddenly and last for a few minutes to a few hours, can include:
• Blurred vision or loss of vision in one eye (amaurosis fugax)
• Difficulty speaking or understanding speech
• Dizziness or loss of balance
• Severe headache
• Weakness or numbness on one side of the body, such as the face or a limb
Stroke
If a carotid artery becomes completely blocked, it can cause a stroke. When deprived of oxygen, brain cells can begin to die within minutes, potentially resulting in permanent brain damage. To help individuals recognize and react to stroke symptoms, many experts use the acronym “FAST:”
• F – Facial drooping – Numbness or visible drooping on one side of the face
• A – Arm weakness – Sudden weakness in one arm, making it difficult to raise both arms evenly
• S – Speech difficulty – Slurred or garbled speech, or trouble understanding spoken words
• T – Time to call 911 – A medical emergency that warrants an immediate trip to an ER
How Is Carotid Artery Disease Diagnosed?
Carotid artery disease is often detected before symptoms develop, usually during a routine medical checkup. Early diagnosis is essential to prevent serious complications, such as stroke.
Several tests may be used to help the physician assess the condition of the carotid arteries and determine the severity of any blockages. These include:
• Physical exam – Using a stethoscope, the physician may listen to the carotid arteries in the neck to check for a bruit, a possible sign of turbulent blood flow caused by arterial narrowing.
• Medical history review – To assess the likelihood of carotid artery disease, the physician will review the patient’s personal and family health history along with any risk factors, such as smoking, high blood pressure, diabetes and high cholesterol.
• Carotid ultrasound (Doppler ultrasound) – The most frequently used diagnostic test for carotid artery disease, Doppler ultrasound is a noninvasive imaging modality that uses sound waves to create detailed visuals of the carotid arteries, which can help the physician evaluate their structure, function and blood flow.
• Computed tomography angiography (CTA) – CTA uses X-rays and contrast dye to produce detailed images of the carotid arteries, which can help the physician detect narrowing and obstructions.
• Magnetic resonance angiography (MRA) – MRA uses magnetic fields and radio waves to create detailed visuals of the arteries, which can help the physician assess blood flow without using radiation.
• Carotid angiography (cerebral angiography) – Usually reserved for cases in which other imaging techniques do not provide sufficient detail, this minimally invasive procedure involves injecting contrast dye into the carotid arteries through a catheter inserted into a blood vessel, typically in the groin.
• Blood testing – The physician may order blood work to check for risk factors associated with carotid artery disease, such as high cholesterol, high blood sugar and inflammation markers.
Diagnosing carotid artery disease early can allow for timely intervention to reduce the risk of stroke. Individuals with risk factors should undergo regular screenings, and those experiencing symptoms, such as dizziness or TIA, should seek immediate medical evaluation.
How Is Carotid Artery Disease Treated?
Treatment for carotid artery disease focuses on reducing the risk of stroke by improving blood flow to the brain and preventing further narrowing of the arteries. The specific approach can vary based on the severity of the narrowing, the related symptoms and the overall health of the patient. Options may include:
Lifestyle Modifications
Potentially effective ways to slow the progression of carotid artery disease and reduce the risk of complications include:
• Consuming a heart-healthy diet – Eating a diet rich in fruits, vegetables, whole grains and lean proteins and low in saturated fats, trans fats and sodium can help lower cholesterol and blood pressure.
• Engaging in regular exercise – Moderate physical activity, such as walking, swimming or cycling, can help maintain cardiovascular health and support weight management.
• Managing blood pressure and blood sugar levels – Controlling hypertension and diabetes is essential for reducing strain on the arteries.
• Quitting tobacco – Smoking cessation is one of the most important steps in preventing further artery damage and reducing stroke risk.
Medications
The physician may prescribe certain drugs to manage risk factors and prevent blood clots that could lead to stroke. Options may include:
• Antiplatelet medications – Antiplatelet medications, such as aspirin and clopidogrel, can help prevent platelets from sticking together and forming blood clots.
• Blood pressure medications – Angiotensin-converting-enzyme (ACE) inhibitors, beta-blockers and diuretics can help control high blood pressure and reduce strain on the arteries.
• Cholesterol-lowering medications – Statins and other lipid-lowering drugs can reduce cholesterol levels, helping to slow the progression of plaque buildup in the arteries.
• Diabetes medications – Managing blood sugar levels with appropriate drugs can help prevent further artery damage.
Minimally Invasive Interventions
For a patient who has significant narrowing of the carotid arteries but is not a candidate for surgery, a minimally invasive procedure can help restore blood flow to the brain. Options may include:
• Carotid angioplasty and stenting (CAS) – After inserting a catheter with a balloon-like device into the narrowed artery to widen it, the physician will place a small mesh tube (stent) to hold the artery open and prevent future narrowing.
• Transcarotid artery revascularization (TCAR) – The physician will insert a stent in a narrowed carotid artery to temporarily reverse blood flow and help reduce stroke risk.
Surgical Procedures
Surgery may be considered for a patient with severe carotid artery narrowing (typically 70% or greater) or prior TIA or stroke. Possible approaches include:
• Carotid endarterectomy (CEA) – The most common surgical procedure for carotid artery disease, CEA involves making an incision in the neck and removing plaque from the narrowed artery to improve blood flow.
• Bypass surgery – Rarely, if other treatments are not viable, the surgeon may create a new path for blood flow by grafting a healthy vessel around the blockage.
What Are the Possible Complications and Long-Term Effects of Carotid Artery Disease?
If left untreated, carotid artery disease can have serious consequences. Some of its most significant complications and long-term effects include:
• Cognitive decline – Over time, reduced blood flow to the brain may contribute to memory loss, difficulty concentrating and increased risk of vascular dementia.
• Chronic ischemia – A prolonged decrease in the supply of oxygen-rich blood to the brain can lead to gradual neurological deterioration, increasing the risk of long-term cognitive and motor function impairment.
• Heart attack – Often associated with systemic atherosclerosis, carotid artery disease can increase the risk of coronary artery disease and heart attack.
• Reduced quality of life – If left unmanaged, carotid artery disease can lead to long-term disabilities, decreased independence and a greater reliance on medical care.
• Stroke – A blockage or blood clot originating from a carotid artery can disrupt blood flow to the brain and lead to a stroke, which may cause permanent neurological damage.
• Transient ischemic attack – TIA is a temporary blockage of blood flow to the brain. While the symptoms typically resolve within 24 hours, a mini-stroke is often a precursor to a full stroke.
How Can Carotid Artery Disease Be Prevented?
Preventing carotid artery disease involves adopting and maintaining heart-healthy habits and managing any known risk factors that can contribute to plaque buildup in the arteries. The same lifestyle modifications recommended for treating carotid artery disease can be effective in preventing the condition as well.
Living With Carotid Artery Disease
Managing carotid artery disease requires a proactive approach to maintaining overall heart health and reducing the risk of complications, such as stroke. In addition to adopting a heart-conscious lifestyle—which includes eating a nutritious diet, exercising regularly and controlling blood pressure, blood sugar and cholesterol levels—an at-risk individual may need to adhere to a prescribed medication regimen, which may involve blood thinners or statins to help prevent further plaque buildup and reduce the risk of blood clots. Regular follow-ups with a healthcare provider are essential for monitoring the progression of carotid artery disease and adjusting the treatment plan as needed.
Benefit From World-Class Care at TGH
Tampa General Hospital’s Heart and Vascular Institute is nationally recognized for providing advanced, individualized care for patients with carotid artery disease and other complex cardiac conditions. We are proud to be recognized as a top hospital in the nation for Heart & Vascular Care by U.S. News & World Report for 2025-26 and the only hospital in the Tampa Bay area to be included in the list of “100 Hospitals and Health Systems with Great Heart Programs” compiled by Becker’s Hospital Review.
If you would like to learn more about carotid artery disease, contact TGH at (813) 822-3627to request an appointment with an expert in our comprehensive Heart and Vascular Institute.