From the Guidelines
Carotid stenosis often presents with symptoms such as transient ischemic attacks (TIAs) or "mini-strokes" characterized by temporary weakness, numbness, or tingling on one side of the body, especially in the face, arm, or leg, and patients may experience sudden vision loss in one eye (amaurosis fugax), slurred speech, difficulty understanding others, dizziness, or confusion that resolves within minutes to hours. These symptoms occur because carotid stenosis involves narrowing of the carotid arteries due to plaque buildup, restricting blood flow to the brain. The symptoms of carotid stenosis can be divided into several categories, including:
- Transient ischemic attacks (TIAs) or "mini-strokes" characterized by temporary weakness, numbness, or tingling on one side of the body, especially in the face, arm, or leg
- Sudden vision loss in one eye (amaurosis fugax)
- Slurred speech
- Difficulty understanding others
- Dizziness
- Confusion that resolves within minutes to hours
- Severe headaches, particularly on the same side as the affected carotid artery Risk factors for carotid stenosis include hypertension, smoking, diabetes, high cholesterol, and advanced age 1. If you experience any of these symptoms, seek immediate medical attention as they may indicate an impending stroke. Diagnosis typically involves ultrasound, CT angiography, or MRI, and treatment options range from medication management with antiplatelet drugs and statins to surgical interventions like carotid endarterectomy or stenting for severe cases 1. According to the Canadian Stroke Best Practice Recommendations, patients with recent transient ischemic attack or non-disabling stroke and ipsilateral 50 to 99 percent symptomatic carotid stenosis should have an evaluation by a clinician with stroke expertise and selected patients should be offered carotid end-arterectomy (revascularization) as soon as possible 1. Carotid endarterectomy should be performed by a surgeon/center that routinely audits their performance results, especially perioperative stroke and death rates, and carotid stenting may be considered for patients who are not operative candidates for technical, anatomic, or medical reasons 1.
From the Research
Symptoms of Carotid Stenosis
The symptoms of carotid stenosis can vary, but common symptoms include:
- Transient ischemic attacks (TIAs) 2, 3, 4, 5
- Amaurosis fugax (temporary blindness in one eye) 2, 3, 5
- Ipsilateral stroke (stroke on the same side as the carotid stenosis) 2, 3, 4, 5
- Unilateral weakness (weakness on one side of the body) 4
- Nonhemispheric symptoms (symptoms that do not affect the brain) 5
Risk Factors for Symptomatic Carotid Stenosis
Several risk factors have been identified for symptomatic carotid stenosis, including:
- Male sex 4
- Age 4
- History of stroke or TIA 4, 5
- Ischemic heart disease 5
- High-grade carotid stenosis (70-99% stenosis) 2, 3
- Presence of an intracranial aneurysm 6
Diagnosis and Treatment
Diagnosis of carotid stenosis is typically made using Doppler ultrasound or other imaging modalities 2. Treatment options for symptomatic carotid stenosis include: