Five things you should know about carotid artery stenosis
Cardiovascular diseases, which include heart disease and stroke, claimed more lives in the United States than the next two leading causes of death – all forms of cancer and accidental deaths – combined. An American is killed by a stroke about every three minutes and 11 seconds, according to estimates published in 2025 by the American Heart Association/ American Stroke Association.
One of the leading causes of stroke is carotid artery stenosis – also known as carotid artery disease. Ramachandra Tummala, MD, a vascular neurosurgeon with M Health Fairview and a professor with the University of Minnesota Medical School, tells us five things we should know about carotid artery stenosis and its link to stroke risk.
Carotid stenosis occurs when plaque buildup begins blocking blood flow.
Stenosis is a medical term for narrowing of blood vessels in the body due to a buildup of plaque, which is formed by inflammatory substances and cholesterol deposits. The carotid arteries start in your neck and go all the way up into the brain. You have one on each side, and these carry most of the blood flow from your heart to your brain. Narrowing of these arteries is known as carotid artery stenosis, and this tends to occur in the neck near the level of the jaw.
Carotid artery stenosis can lead to a stroke.
People who have carotid artery stenosis are at increased risk for a stroke, which can lead to disability or death. Sometimes, strokes can be mild and recoverable. In other cases, strokes are very large and devastating. Occasionally strokes are fatal.
Carotid stenosis can cause a stroke in two ways. Often, plaque lodged in the carotid arteries comes loose and goes downstream into the blood vessels in the brain, where it blocks blood flow. We call that an embolism. The other, less common cause is when the carotid artery blockage becomes so severe that it actually slows down the blood flow to the brain.
Carotid artery stenosis can be a sign of a more significant problem.
If there is blockage in the carotid arteries, it’s likely that there’s buildup in other arteries throughout the body, Tummala said.
Factors that put you at greater risk include:
- Poorly controlled high blood pressure
- Diabetes
- Smoking
- Obesity
- An unhealthy diet - high saturated fats, high levels of carbohydrates and processed sugars
- Sedentary lifestyle
- Family history/Genetics
In general, heart risk and stroke risk largely follow one another. Good heart health practices, such as managing stress and engaging in physical activity, can help reduce carotid artery stenosis – and therefore stroke risk.
The older you are, the higher your risk.
Plaque buildup happens in every adult. But not all plaque buildup will cause a stroke. The older you are, the higher the risk for buildup is. Men are more likely to experience plaque buildup than women. On the other hand, younger patients with carotid stenosis can have a higher lifetime risk of stroke
Carotid stenosis is classified as symptomatic and asymptomatic. This is by far, the most important factor in determining stroke risk. Symptomatic carotid artery stenosis is more important because it means the narrowing has already caused a stroke or brief stroke symptoms. Symptomatic stenosis is associated with a higher risk of a stroke or another stroke. Asymptomatic stenosis carries less stroke risk. Sometimes, stenosis can be detected by a primary care provider before symptoms occur.
Carotid stenosis is also classified as mild, moderate, or severe. The more narrowed the artery, the higher the stroke risk. But symptoms are more important than the amount of narrowing.
Some patients may experience stroke-like symptoms, such as with a transient ischemic attack (TIA, sometimes referred to as a ministroke). These symptoms can include:
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Trouble speaking or seeing
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Sudden numbness
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Dizziness
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Weakness on one side of the body
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Weakness on one side of the face
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A severe headache.
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Vision changes, especially a loss of vision in one eye
People who experience these symptoms should go to the emergency department because one in five people who have a TIA attack go on to have a stroke within 90 days.
Treatment includes medical management or possibly a procedure to reduce stenosis in the carotid artery.
At M Health Fairview, treatment is individualized based on whether the person is having symptoms, how severe the stenosis is, how old the person is, and the person’s unique health history.
Based on those factors, there are three possible ways to manage the disease:
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Medical management, which may involve lifestyle changes like a cholesterol-lowering diet, and medications to reduce risk. That could include aspirin, blood pressure, or cholesterol medication.
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Surgery called carotid endarterectomy is a preventive procedure that removes the plaque from the inside of the carotid artery in the neck This operation has been evaluated rigorously over the past 70 years and is a very effective method to lower stroke risk in certain patients, especially those with symptomatic severe stenosis.
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Carotid stent placement, a less invasive procedure that involves the placement of a small, expandable stent in the carotid artery to improve blood flow. This has been studied rigorously for about 30 years and is effective in certain patients, especially those patients whose surgical risk is high for the endarterectomy. The stent can be placed through the groin, the wrist, or through a small incision in the neck.
