Arterial disease
Carotid Artery Disease
Narrowing of the neck arteries that supply the brain — a major treatable cause of stroke. Assessed by duplex ultrasound at consultation in Singapore.
Last reviewed 30 Jun 2026
Reviewed by Dr Tay Jia Sheng · Vascular, Endovascular & General Surgeon
What is carotid artery disease?
The carotid arteries in the neck carry blood to the brain. Cholesterol plaque builds up in them just as it does in heart and leg arteries, narrowing the channel — a condition I assess and treat in Singapore. The danger is less the narrowing itself than the plaque's surface: fragments can break away, travel to the brain, and cause a stroke or transient ischaemic attack (TIA) — a "mini-stroke" whose symptoms resolve but whose warning should never be ignored.
Who is at risk
The same factors that drive arterial disease elsewhere: smoking, high blood pressure, diabetes, high cholesterol, age and family history. Carotid disease often coexists with peripheral arterial disease and heart disease — finding one should prompt thinking about the others.
Symptoms — and the absence of symptoms
Many carotid narrowings are silent until an event happens. Warning symptoms that demand urgent assessment include:
- Sudden weakness or numbness of the face, arm or leg, especially one-sided
- Sudden slurred speech or difficulty finding words
- Sudden loss of vision in one eye, like a curtain coming down (amaurosis fugax)
Even if these resolve within minutes, they mark a window of high stroke risk in the days that follow — and it is in that window that early treatment reduces the risk of a completed stroke the most.
How it is assessed
A carotid duplex ultrasound — painless, radiation-free, done at consultation — measures the degree of narrowing and characterises the plaque. CT or MR angiography refines the picture where intervention is being considered.
Treatment options
- Best medical therapy for all: antiplatelet medication, statins, blood pressure and diabetes control, and stopping smoking
- Carotid endarterectomy — open surgical removal of the plaque, the long-established operation for significant symptomatic narrowing
- Carotid artery stenting — an endovascular alternative in selected patients, reopening the artery through a small puncture
The choice between them depends on the degree of narrowing, symptoms, anatomy and overall health — and is made with the patient, not for them. I perform both carotid endarterectomy and carotid artery stenting myself — one of a small number of vascular surgeons in Singapore who offer both — so that recommendation rests on what suits your case, not on which procedure happens to be available.
When to see a doctor promptly
Any stroke-like symptom, however brief, is an emergency. A known narrowing that has caused symptoms should be assessed within days, not weeks.
Frequently asked questions
- Can carotid artery disease be present without any symptoms?
- Yes — many carotid narrowings are silent until a stroke or transient ischaemic attack happens. That is why a carotid duplex ultrasound is worth considering if you have the risk factors for arterial disease, or if you already have peripheral arterial disease or heart disease, since these conditions often coexist.
- What is a transient ischaemic attack, and why does it matter if it went away?
- A TIA is a stroke-like episode — one-sided weakness, slurred speech, or a curtain of lost vision in one eye — whose symptoms resolve within minutes or hours. It matters because it marks a window of high stroke risk in the days that follow, and that is exactly the window in which early treatment reduces the risk of a completed stroke the most. Treat it as an emergency, not a relief.
- How is carotid narrowing measured?
- With a carotid duplex ultrasound done at the consultation — painless, radiation-free, and able to both measure the degree of narrowing and characterise the plaque itself. Where intervention is being considered, CT or MR angiography refines the picture.
- Does every carotid narrowing need an operation?
- No. Best medical therapy — antiplatelet medication, statins, blood pressure and diabetes control, and stopping smoking — is the foundation for everyone. Whether to add carotid endarterectomy or stenting depends on the degree of narrowing, whether it has caused symptoms, your anatomy and your overall health, and that decision is made with you at consultation.
- What is the difference between carotid endarterectomy and carotid stenting?
- Endarterectomy is the open operation that removes the plaque through an incision in the neck and is the long-established treatment for significant symptomatic narrowing. Stenting reopens the artery from inside through a small puncture and is an alternative in selected patients. I perform both, so the recommendation rests on what suits your case.