Carotid Artery Disease
The carotid arteries carry blood from the heart up to the brain. When they narrow with plaque, the risk of stroke rises sharply. At MVM, we screen, diagnose, and manage carotid disease - and coordinate intervention when stroke risk warrants it.
What is carotid artery disease?
Carotid artery disease is the narrowing of the carotid arteries - the two large vessels in the neck that carry blood from the heart to the brain. The cause is the same atherosclerosis that underlies coronary disease and PAD: gradual buildup of plaque along the inner wall of the artery.
Two problems can arise. First, severe narrowing can reduce blood flow to the brain. Second, and more commonly, a piece of plaque or a clot that forms on plaque can break off and travel to the brain, blocking a smaller artery - causing a stroke or transient ischemic attack (TIA).
Carotid disease is often silent until it causes a TIA or stroke. That's why it's often found incidentally on imaging done for another reason, or when a physician hears a bruit (a swooshing sound) in the neck during a routine exam. When found, the right management depends on the degree of narrowing, whether the patient has had symptoms, and overall stroke risk.
How MVM treats carotid disease.
Patients and referring physicians choose MVM for carotid disease because we know which patients need intervention, which need careful medical management, and which need urgent escalation - and we don't confuse those categories.
- Same-week consults. New carotid patients are typically seen within 5 business days. Recent stroke or TIA is prioritized for same-day evaluation.
- In-office carotid ultrasound. Duplex ultrasound of both carotid arteries performed in our office, often the same visit.
- Optimal medical therapy. Antiplatelet therapy, statins, blood pressure control, and risk-factor management - the foundation of carotid care.
- Stroke-risk stratification. Clear conversations about which patients benefit from intervention vs. medical management alone.
- Coordinated intervention when needed. Carotid endarterectomy (surgical) or carotid stenting (endovascular) with high-volume specialists, with shared follow-up.
- One specialist, full continuum. The doctor who diagnoses you also manages your medications, follow-up imaging, and downstream cardiovascular care.
Schedule a carotid consultation.
Most patients are seen within a week. Recent TIA or stroke is seen faster. Bring any prior carotid imaging, your medication list, and a written summary of your symptoms.
Schedule a consultationSend us a carotid referral.
Same-week consults for asymptomatic carotid stenosis and incidental findings. Recent TIA/stroke triaged for same-day or next-day evaluation. Closed-loop reporting back to your office within 48 hours.
Referral processCommon carotid disease symptoms.
Carotid disease is usually silent. When it does cause symptoms, those symptoms are urgent - they typically signal a TIA or stroke.
- Most patients have no symptoms until a TIA or stroke occurs
- Sudden weakness or numbness on one side of the body
- Trouble speaking or understanding speech
- Sudden vision changes in one eye - sometimes described as a curtain coming down
- Sudden severe headache with no known cause
- Dizziness, loss of balance, or trouble walking
- A bruit - a swooshing sound a physician hears in the neck during exam
- Brief symptoms that fully resolve (TIA) - these are warning strokes and must not be ignored
Who is most at risk.
- Age over 65
- High blood pressure
- High cholesterol
- Diabetes
- Smoking (current or past)
- Coronary artery disease or PAD - strong predictors of carotid involvement
- Family history of stroke or cardiovascular disease
- Chronic kidney disease
How we diagnose carotid disease at MVM.
Most patients leave their first visit with a clear assessment of stroke risk and a plan.
- Focused history and exam - including listening to the neck for a bruit
- Carotid duplex ultrasound - the primary screening test, performed in our office
- CT angiography (CTA) - detailed imaging of carotid and cerebral vessels for borderline or complex cases
- MR angiography (MRA) - alternative when CT contrast is contraindicated
- Cerebral angiography - direct vessel imaging when needed for procedural planning
- Brain imaging - CT or MRI when stroke or TIA is suspected
Treatment options.
The right treatment depends on how narrowed the artery is and whether the patient has had symptoms. For most patients with moderate disease, optimal medical therapy is the foundation. Intervention is reserved for higher-risk situations where the benefit clearly outweighs the procedural risk.
Optimal medical therapy
The foundation of carotid care is aggressive cardiovascular risk reduction: antiplatelet therapy (typically aspirin or clopidogrel), high-intensity statin therapy, blood pressure control, smoking cessation, and diabetes optimization. For many patients with moderate carotid narrowing, this is the right answer - and the evidence supporting it is strong.
Procedural options
For symptomatic patients with significant narrowing - or selected asymptomatic patients with severe disease and acceptable procedural risk - intervention may be appropriate:
- Carotid endarterectomy (CEA) - surgical removal of plaque through a neck incision; the long-standing gold standard for many patients
- Carotid artery stenting (CAS) - endovascular placement of a stent to hold the artery open, often with an embolic protection device
- Transcarotid artery revascularization (TCAR) - a hybrid approach that combines a small neck incision with stenting and flow reversal to reduce stroke risk during the procedure
We coordinate these interventions with high-volume surgical and endovascular teams and stay involved in your pre- and post-procedural care.
Recovery and ongoing care
Most patients return to normal activity within 1–2 weeks after carotid endarterectomy, sooner with stenting. We follow with periodic ultrasound - typically at 6 months, 1 year, and annually thereafter - alongside continued medical therapy.
When to see a specialist.
- An incidental finding of carotid plaque or narrowing on imaging
- A carotid bruit heard during a routine exam
- A history of TIA or minor stroke - even one that resolved completely
- Known PAD, CAD, or strong risk-factor profile and no prior carotid screening
- A recommendation for carotid surgery or stenting - second opinions welcome
Call 911 immediately if you experience sudden weakness or numbness on one side, trouble speaking, loss of vision in one eye, severe sudden headache, or sudden loss of balance. These can be signs of a stroke. Time-to-treatment determines outcome - every minute matters.
Carotid disease FAQs.
If I have carotid narrowing, do I need surgery?
Not necessarily. For many patients with moderate carotid disease, optimal medical therapy is the right answer. Intervention is reserved for severe narrowing and for patients who have had symptoms (TIA or stroke). The decision is individualized - we walk through it carefully with you.
What is a TIA, and how is it different from a stroke?
A TIA (transient ischemic attack) is a brief episode of stroke-like symptoms that resolves within minutes to hours. It signals that a stroke is now significantly more likely. A TIA is not less important than a stroke - it's a warning that must be acted on quickly.
How often should my carotids be re-imaged?
It depends on the degree of narrowing. Mild disease may need imaging every 1–2 years; moderate disease, annually; severe disease, every 6 months. We set the schedule with you based on your imaging and risk profile.
Can carotid plaque be reversed?
Plaque doesn't usually disappear, but it can be stabilized with aggressive lipid-lowering and risk-factor management. Stabilization is what matters - a stable plaque is far less likely to cause stroke than an active one.
Will I be on blood thinners?
Most carotid patients are on an antiplatelet drug like aspirin or clopidogrel - not full anticoagulation. The exception is patients with other indications, such as atrial fibrillation. We tailor the regimen to your full cardiovascular picture.
Schedule a carotid consultation.
Most new patients are seen within a week. Recent TIA or stroke is seen faster. Bring any prior carotid imaging, the medication list, and a written summary of your symptoms - we'll do the rest.