Carotid artery stenosis is the narrowing of the main vessels that supply the brain and is one of the most important causes of stroke. Approximately 200,000 stroke cases occur in Turkey each year, a significant portion of which are related to carotid disease.
What is Carotid Artery Stenosis?#
The carotid arteries are the main vessels located on both sides of the neck that supply most of the brain. Carotid stenosis is the narrowing of these arteries due to atherosclerosis.
Carotid stenosis can cause stroke in two ways:
- Embolic stroke: Pieces breaking off from plaque blocking brain vessels
- Hemodynamic stroke: Insufficient blood flow to the brain due to severe narrowing
Symptoms of Carotid Stenosis#
Carotid stenosis usually does not cause symptoms and is called a “silent killer.” However, warning signs may be seen in some patients:
Transient Ischemic Attack (TIA)#
Also known as “mini stroke,” TIA is a harbinger of stroke:
- Sudden vision loss (in one eye)
- Numbness/weakness in face, arm, or leg
- Difficulty speaking
- Loss of balance
- Symptoms completely resolve within 24 hours
Stroke Symptoms#
- Sudden facial drooping
- Weakness in arm or leg
- Speech disturbance
- Vision loss
- Severe headache
⚠️ FAST Rule: Face, Arm, Speech, Time - Call for emergency help with these symptoms!
Risk Factors#
Risk factors for carotid stenosis:
- Advanced age (>65)
- Smoking
- Hypertension
- Diabetes
- High cholesterol
- Coronary artery disease
- Peripheral artery disease
- Family history
Diagnostic Methods#
Non-Invasive Tests#
Carotid Doppler Ultrasonography:
- First preferred screening method
- Assessment of stenosis degree and plaque structure
- Painless and radiation-free
CT Angiography:
- Detailed anatomical imaging
- Calcification assessment
- For treatment planning
MR Angiography:
- Contrast-free imaging option
- Soft tissue details
Invasive Diagnosis#
Cerebral Angiography:
- Gold standard
- Can be done simultaneously with treatment
Our Treatment Approaches#
Medical Treatment#
Basic treatment in all carotid stenosis patients:
- Antiplatelet therapy (aspirin, clopidogrel)
- High-dose statin
- Hypertension control
- Diabetes management
- Smoking cessation
Carotid Stenting (CAS)#
Minimally invasive endovascular treatment:
Indications:
- Symptomatic patients: ≥50% stenosis
- Asymptomatic patients: ≥70% stenosis (in selected cases)
- High surgical risk patients
- Post-radiation stenosis
- Post-surgical restenosis
How is the Procedure Performed?
- Access through groin artery
- Placement of protective filter (embolic protection device)
- Pre-dilation with balloon
- Stent placement
- Post-dilation with balloon
- Filter removal
Carotid Endarterectomy (CEA)#
Surgical treatment option:
- Surgical removal of plaque
- Preferred in low surgical risk patients
- Long-term results proven
Stenting or Surgery?#
Both treatments have advantages:
| Feature | Stenting (CAS) | Surgery (CEA) |
|---|---|---|
| Invasiveness | Minimal | Open surgery |
| Anesthesia | Local | General/local |
| Recovery | Fast | Longer |
| Cranial nerve injury | None | Possible |
| Myocardial infarction risk | Low | Higher |
| Stroke risk | Similar | Similar |
The decision is made individually based on patient anatomy, risk factors, and preference.
Carotid Stenting Risks#
Procedure risks:
- Stroke (1-3%)
- Transient bradycardia/hypotension
- Access site complications
- Contrast nephropathy
- Restenosis (rare)
Post-Procedure Care#
After carotid stenting:
In Hospital:
- Neurological monitoring
- Blood pressure control
- Access site monitoring
After Discharge:
- Dual antiplatelet therapy (at least 1 month)
- Statin therapy
- Risk factor control
- Regular Doppler follow-up
Frequently Asked Questions#
Does carotid stenosis always require treatment?
Does carotid stenting prevent stroke?
Can I return to normal life after stenting?
Does the carotid stent last a lifetime?
What is done if both carotids are narrowed?
Appointment and Contact#
If you would like to schedule an appointment for carotid stenosis evaluation or treatment:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Peripheral Vascular Treatments#
Other peripheral vascular treatments related to carotid stenosis:
- Peripheral Vascular - Peripheral vascular disease
- Renal Artery Stenosis - Renal artery stenosis treatment
- Lower Extremity Arterial Disease - Leg artery disease
- Atherectomy - Plaque removal procedure
- Hypertension - High blood pressure treatment