CAROTID ARTERY DISEASE

Carotid artery disease occurs when the carotid arteries — the two main arteries in the neck that supply blood to the brain — become narrowed by a build-up of fatty deposits (atherosclerosis). This narrowing, known as carotid stenosis, can restrict blood flow to the brain and is one of the leading causes of stroke in the UK.

Carotid artery disease is responsible for approximately 20% of all ischaemic strokes. Stroke is the third most common cause of death and the leading cause of adult disability in the UK, making timely identification and treatment of carotid stenosis critically important.

Carotid artery disease often produces no symptoms until a transient ischaemic attack (TIA) or stroke occurs. A TIA — sometimes called a 'mini stroke' — causes temporary stroke-like symptoms that resolve completely within 24 hours. It is a medical emergency and a warning sign that a full stroke may follow.

Use the FAST test to recognise stroke symptoms

•    Face — has one side of the face drooped or become numb?
•    Arms — is there weakness or numbness in one arm?
•    Speech — is speech slurred or difficult to understand?
•    Time — call 999 immediately if you notice any of these signs

Other symptoms of carotid artery disease

•    Sudden loss of vision in one eye (amaurosis fugax)
•    Sudden weakness or numbness on one side of the body
•    Difficulty with balance or coordination

If you have experienced any of these symptoms, even briefly, please seek immediate medical attention. Following a TIA, the risk of stroke is highest in the first 48 to 72 hours.

Professor Zayed uses a combination of clinical assessment and imaging to determine the degree of carotid stenosis and the most appropriate management:

•    Duplex carotid ultrasound — the first-line investigation, providing real-time imaging of the carotid artery and measurement of the degree of narrowing
•    CT angiography (CTA) or MR angiography (MRA) — detailed cross-sectional imaging of the carotid and intracranial vessels, used to plan intervention
•    Cardiovascular risk assessment — given the strong association between carotid disease and coronary artery disease, a full cardiovascular review is undertaken

Medical management
All patients with carotid artery disease require optimisation of cardiovascular risk factors, including antiplatelet therapy (aspirin or clopidogrel), a high-dose statin, blood pressure control, and lifestyle modification. These measures reduce the risk of stroke and slow the progression of atherosclerosis.

Carotid endarterectomy (CEA)
Carotid endarterectomy is the gold-standard surgical procedure for significant symptomatic carotid stenosis. Under general or local anaesthetic, the carotid artery is opened and the fatty plaque causing the narrowing is carefully removed, restoring normal blood flow to the brain. The procedure has a well-established evidence base and is most beneficial when performed promptly following a TIA or minor stroke in patients with significant stenosis (typically 50–99%).

Professor Zayed has a large experience with carotid endarterectomy. The operation is usually performed with intraoperative neurological monitoring to minimise the risk of complications.

Carotid artery stenting (CAS)
Carotid artery stenting is a minimally invasive alternative to surgery in which a metal stent is deployed across the narrowed segment via a catheter passed through the groin. It is considered in patients who are at high surgical risk or where the anatomy makes open surgery difficult.