Carotid Artery Disease

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. 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.