Carotid stenosis: diagnosis and specialist treatment

Specialist assessment of carotid stenosis

Carotid stenosis is a narrowing of the carotid arteries — the main blood vessels supplying the brain — which can increase the risk of having a stroke.

At the Carotid Pathology Unit at Publio Cordón Memorial Hospital, a specialist assessment of this condition is carried out using advanced vascular diagnostics to identify the degree of narrowing in the carotid arteries and determine whether medical or interventional treatment is indicated to reduce the risk of stroke.

The narrowing of these arteries is usually caused by the progressive build-up of atherosclerotic plaques, consisting of cholesterol and calcium, on the arterial wall. As well as reducing blood flow to the brain, these plaques can break up and form small clots that travel through the cerebral circulation.

In some patients, this condition manifests as transient neurological episodes, such as weakness on one side of the body, difficulty speaking or sudden loss of vision in one eye, which resolves within a few minutes. These episodes may correspond to a transient ischaemic attack (TIA) and constitute a vascular warning sign requiring specialist medical assessment.

Early identification of carotid stenosis and its assessment by specialists in vascular disease enables the development of a treatment strategy aimed at protecting cerebral circulation and preventing cerebrovascular events.

Clinical impact and progression of carotid stenosis

Carotid stenosis usually develops slowly over a number of years and, in many cases, causes no symptoms during the early stages.

However, when the narrowing of the artery becomes significant or an atherosclerotic plaque becomes unstable, transient neurological symptoms may occur, acting as a vascular warning sign.

The most characteristic symptoms include:

• Sudden weakness in the face, arm or leg, usually on one side of the body

• Difficulty speaking or understanding speech

• Temporary loss of vision in one eye

• Episodes of dizziness or loss of balance

Although these symptoms may disappear within a few minutes or a few hours, they may indicate that blood flow to the brain is compromised and require specialist medical assessment to investigate the condition of the carotid arteries.

Specialist management in the Carotid Pathology Unit

The management of carotid stenosis requires an accurate assessment of the condition of the neck arteries and the risk of cerebrovascular events.

At the Carotid Pathology Unit at the Publio Cordón Memorial Hospital, the assessment focuses on identifying which patients are at high risk of stroke and determining whether treatment should be medical or interventional.

To this end, various clinical factors are analysed, including:

• The degree of narrowing of the artery

• The stability of the atherosclerotic plaque

• The presence of previous neurological symptoms

• The patient’s cardiovascular risk profile

This analysis enables the development of a personalised treatment strategy aimed at reducing the risk of stroke and protecting cerebral blood flow.

Specialist diagnosis of carotid stenosis

Diagnosis begins with a clinical examination and a detailed review of the patient’s neurological history.

The most commonly used initial test is Doppler ultrasound of the supra-aortic trunks, which allows the carotid arteries to be visualised and the blood flow velocity to be measured in order to estimate the degree of narrowing.

When a more precise assessment of the vascular tree is required, advanced imaging techniques may be used, including:

• Computed tomography angiography (CT angiography)

• Magnetic resonance angiography (MRI angiography)

• Conventional arteriography in selected cases

These tests enable the degree of stenosis to be quantified, the morphology of the atherosclerotic plaque to be analysed, and the most appropriate treatment strategy for each patient to be determined.

When to treat carotid stenosis

The main aim of treating carotid stenosis is to reduce the risk of stroke.

In cases of mild or moderate stenosis without neurological symptoms, management usually focuses on intensive control of cardiovascular risk factors through medication and lifestyle changes.

When the narrowing of the artery is significant or has caused neurological symptoms, it may be necessary to perform a procedure directly on the carotid artery to restore blood flow to the brain.

Treatment of carotid stenosis: surgery and stenting

When surgery is indicated, there are two main strategies for treating narrowing of the carotid artery: carotid endarterectomy and endovascular treatment via angioplasty with stent placement.

The choice of technique depends on the characteristics of the stenosis, the anatomy of the neck arteries and the individual assessment carried out by the specialist team.

Carotid endarterectomy

Carotid endarterectomy is a surgical procedure designed to remove the atherosclerotic plaque causing the narrowing of the artery.

During the procedure, the surgeon opens the carotid artery and carefully removes the plaque responsible for the blockage, restoring blood flow to the brain.

This technique has been shown to significantly reduce the risk of stroke in patients with symptomatic or severe carotid stenosis when performed in experienced centres.

Carotid angioplasty with stent placement

In certain cases, particularly where the surgical risk is high or the carotid anatomy warrants it, endovascular treatment via carotid angioplasty with stent placement may be considered.

This procedure involves inserting a catheter through the femoral artery to widen the narrowed area and placing a metal mesh that keeps the artery open, thereby improving blood flow to the brain.

The choice between surgery and endovascular treatment depends on the anatomical characteristics of the lesion, the patient’s general condition and the assessment by the specialist team.

Vascular monitoring and management

Following treatment, clinical follow-up enables the assessment of changes in carotid blood flow and the monitoring of cardiovascular risk factors.

Regular check-ups using Doppler ultrasound enable the stability of the arteries to be monitored and any changes in the progression of the disease to be detected.