This page explains what happens when you are diagnosed with narrowing of the blood vessels in your neck (carotid artery disease), how it is linked to stroke and treatments to reduce your risk of a stroke.

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What are the carotid arteries?

The carotid arteries are blood vessels which take blood to the brain, face and neck. You have two carotid arteries, one on each side of your neck (where you feel your pulse). Mid-neck, each carotid artery splits into two ‘Y’ shaped branches. One branch of the artery reaches the face and scalp, and the other branch travels inside the neck up to the brain.

What is carotid artery disease and what causes it?

In carotid artery disease, the arteries have become narrowed, stiff and clogged with fatty material (plaque). This is called atherosclerosis, and the narrowing it causes is known as carotid artery stenosis.

Our arteries naturally become narrowed as we get older. But some things make it more likely to happen. These are known as risk factors:

  • Medical conditions like high blood pressure, diabetes and high cholesterol can cause atherosclerosis.
  • It’s also more likely to happen to you if it affects a close family member.
  • Smoking is one of the main preventable risk factors for atherosclerosis.
  • Other preventable risk factors include being overweight, not being very active, and eating food with too much fat and salt.

How can carotid artery disease cause a stroke or TIA?

Carotid artery disease can cause a stroke by blocking the blood supply to the brain, killing brain cells. This is known as an ischaemic stroke. Carotid artery disease can also cause a transient ischaemic attack (TIA or mini-stroke).

Carotid artery disease can cause a stroke in several ways:

  1. If plaque (fatty material) completely blocks the carotid artery, it can cut off the blood supply to the brain and cause a stroke. This is known as an occlusion.
  2. The plaque may damage the lining of the carotid artery, causing a blood clot to form that blocks the artery. This is known as thrombosis.
  3. A clot can break off inside the artery and travel to the brain. This is known as an embolic stroke.

Carotid artery disease is a common cause of stroke. Up to 15% of all ischaemic strokes in the UK may be due to this condition.

How do I know if I have carotid artery disease?

Having a stroke or TIA may be the first sign you have carotid artery disease, as it often does not have symptoms.

How is carotid artery disease diagnosed?

You will have scans and checks to find out what caused your stroke, and if your carotid arteries are narrowed, you will be offered treatment to reduce your risk of another stroke.

There are two types of scan typically used to look for carotid artery disease:
• An ultrasound scan can show how much blood is flowing through the vessel. If there is a narrowing (stenosis), the scan will determine if blood flow through the artery has been affected.
• Computed tomography angiography (CTA). This uses a contrast agent (a special dye) injected into a vein in your arm to allow the blood vessels to show up better on screen.

Other scans may be used to find out more detail about the blood vessels, including magnetic resonance angiography (MRA), which creates 3D images and can also use a contrast or dye. Some people may have several scans of their arteries, depending on how easily the arteries can be seen or whether stenosis is present.

Treatments for carotid artery disease

Carotid artery disease may be treated using surgery or medication and lifestyle changes. The treatment you’re offered depends on your individual risk of having another stroke.

Surgery

You’ll only be offered a surgical procedure if doctors think it will substantially reduce your risk of having another stroke. If the artery is narrowed by over 50% (also known as moderate to severe stenosis) and doctors think you have a high risk of another stroke, you may be offered a surgical procedure to repair the artery. This should be carried out as soon as possible after your stroke or TIA.

Your personal risk of a stroke depends on things like how narrowed your arteries are, if you have had a previous stroke, your age and other health conditions you might have. Your doctor will assess you to help decide what treatment you need. They should help you understand your treatment, discuss the benefits and risks, and answer any questions you have.

There are two main surgical procedures for carotid artery disease: carotid endarterectomy and carotid artery stenting.

This webpage can only give general information. Ask your doctor to help you understand your individual risk and the benefits of any operation.

Carotid endarterectomy is an operation to remove the inner lining of the narrowed part of your artery and any plaque. It can be done under local or general anaesthetic. The operation usually takes around one to two hours. 

If you smoke, you will be advised to stop smoking before the operation. Smoking reduces the amount of oxygen in your blood and can increase your risk of breathing problems during the procedure or getting a chest infection.

What happens in the procedure? 

  1. The carotid artery is clamped shut.
  2. Sometimes a shunt (small piece of tubing) is used to re-route the blood flow to the brain during the operation.
  3. The artery is opened up and the lining removed, along with the fatty deposits.
  4. The artery is closed with stitches, or using an artificial patch or graft from another blood vessel.
  5. The skin is stitched up, leaving a fine scar about 7-10cm long that should fade with time. 

What are the benefits and risks? 

Carotid endarterectomy can reduce your risk of having another stroke or TIA. 

Like all operations, carotid endarterectomy has some risks attached, including some minor and more serious complications. Complications are more likely if you are older, a smoker, or have had a recent stroke. You can also be more at risk of complications if you have narrowing in both carotid arteries, and if you have other health conditions such as heart disease and high blood pressure. 

Serious complications 

Most people who have the procedure will not have serious complications. However, there is a small risk (between about 1% to 3%) of having a stroke during surgery, due to the chance of a small blood clot developing during the operation and travelling to your brain. There can also be a very small risk of dying, usually due to a complication such as a severe stroke or heart attack soon after the operation.

Other complications 

• Wound infection. This is rare and can be treated with antibiotics. 

• Bleeding from the site of your wound. 

• Nerve injury. This can cause a hoarse voice, weakness, or numbness on one side of your face. These symptoms usually disappear within a month. 

• Numbness or slight pain around your wound, which can be treated with painkillers.

• The arteries becoming blocked again. A small number of people may need to have further surgery. 

Recovery 

Many people can leave hospital after 48 hours. Your surgeon will give you advice about when you can go back to your usual activities or restart work. This includes avoiding physical activity or exercise for a few weeks, to allow the wound time to heal. If both of your carotid arteries need surgery, this is usually done in separate operations. 

Driving 

You cannot drive after surgery until you have recovered enough to perform an emergency stop safely and look over your shoulder. This can take a few weeks. Always ask your doctor for individual advice. 

Remember you also cannot drive for at least one month after a stroke or TIA. Read our driving pages for more information. 

Stenting uses a metal mesh cylinder to keep the artery open. Unlike endarterectomy, it does not involve opening up the neck. It’s done under local anaesthetic. 

What happens in the procedure? 

  1. A thin, flexible tube goes into an artery in your groin, and is passed up to the neck.
  2. The tube is guided through your arteries using a live X-ray. You’re injected with a contrast (also known as dye) so the arteries show up on the screen.
  3. When the tube reaches the neck, a tiny balloon is inflated in the carotid artery.
  4. The stent (a mesh cylinder) goes into the balloon and keeps the artery open.
  5. The balloon is removed, leaving the stent in place. Recovery After the operation, you will need to lie flat and still for an hour or so to prevent bleeding from the artery. Most people can go home the next day. 

What are the benefits and risks? 

As with carotid endarterectomy, complications can occur after the stenting procedure. In some people, the risk of a stroke or dying due to stenting may be slightly higher than with endarterectomy, but stenting is a less invasive procedure and is as effective at reducing strokes in the long-term. 

You will be assessed to help decide which procedure is best for you. Your doctor should explain the benefits and risks, along with reasons why they’re advising stenting rather than endarterectomy. 

Other possible complications 

  • Bruising where the tube enters your femoral artery.
  • A small chance of bleeding from this point, which may need to be repaired.
  • An allergic reaction or kidney problems due to the X-ray contrast dye.
  • A blockage or rupture in your carotid artery – this is very rare but may need to be treated with a stent. If this is not possible, an operation may be needed to repair your artery.

Your doctor should work with you to help you understand why you need a procedure and what the benefits are. They should also explain the risks and what to expect afterwards. 

To help you understand your options, we’ve put together a question checklist. You can use it when you’re speaking to the hospital doctor or your GP. You may want to write down the answers and discuss them with family or friends. 

Question checklist: carotid artery disease treatment 

  1. What is the success rate for this operation at this hospital?
  2. Is endarterectomy or stenting best for me, and why? What are the benefits?
  3. If I do not have the operation, how likely am I to have a stroke?
  4. Am I at an increased risk during this operation because I’ve had a stroke or TIA?
  5. Can I choose to have a local or a general anaesthetic?
  6. Is it likely that I will have to have this operation again in the future?
  7. Do you have a diagram or patient information to help explain the operation?

Other treatment options

If your artery is less than 50% narrowed, your medical team may decide that you will benefit from different types of treatment.

Medication can be very effective in reducing your risk of a stroke. For example, blood-thinning medication can reduce the risk of another clot forming, and medication for high blood pressure, diabetes and high cholesterol can reduce the build-up of fatty materials in your arteries.

You’ll be given advice about how to make healthy lifestyle changes too, such as stopping smoking if you smoke, or support for losing weight if you need to.

Our Managing Risk section has more information on how to reduce your risk of a stroke.

Resources

This guide outlines how carotid artery disease develops, who is at risk of it, and what treatment options are available. It also explains why a healthy lifestyle is particularly important if you have carotid artery disease.

Accessible formats

To view all of our resources, visit our resources area.

Written and edited by
Jenny Simpson , Jonathan Jones , Gemma Harris