The carotid arteries are the main blood vessels taking blood from the heart to the brain. There is one on either side of the neck and its pulse can be felt just under the jaw. The carotid artery branches into the external and internal carotid artery, which supplies the brain. At this branch point, there is an increased risk of plaque building up, thereby causing a narrowing of the vessel. This is known as carotid artery stenosis. If the plaque remains stable, there are no observable symptoms. If small pieces of the plaque break off and travel to the brain, they can cause mini-strokes or TIAs (transient ischaemic attacks). Often patients will experience symptoms of weakness or loss of sensation in a limb, or a transient loss of vision in one eye. These symptoms last for 24 hours or less before resolving completely. If a large piece of plaque breaks off and blocks a small artery in the brain, the patient will experience a stroke, which can have life-threatening consequences.

Simple imaging known as a carotid doppler scan, is used to monitor carotid stenosis. It is a non-invasive ultrasound scan that measures the amount of narrowing in the vessel. Other imaging modalities such as CT or MRI angiograms are  used to get more detailed images if the disease is more complex or plan for operative intervention when required.

Patients with a significant carotid plaque and neurological symptoms are referred for surgery as the evidence from clinical trials shows that the risk of stroke is dramatically decreased as soon as the plaque is removed. The operation is called carotid endarterectomy. In the majority of cases, it is performed under local anaesthetic and involves opening the artery and removing the plaque. Most patients are able to be discharged the following day after an overnight stay in hospital. In experience hands complication rates from carotid endarterectomy are less than 2%.

Carotid artery stenting is a relatively new procedure, which is still being evaluated for efficacy and safety. It involves placing a catheter into the narrow segment of the carotid artery and expanding a metallic stent in order to open up the artery, thereby restoring blood flow. Currently carotid artery stenting is used for patients who had contraindications for carotid endarterectomy or patients who had re-stenosis after previous carotid surgery.

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Carotid Artery Disease and Stroke