Diagnosing and Treating Carotid Occlusive Disease

An individual suspected to have carotid stenosis, or who may have had a transient ischemic attack (a TIA, or “mini-stroke”)  is first assessed with a thorough physical examination. This examination can reveal specific neurological, motor, and sensory deficits that can provide clues about both the extent and location of an occlusion.

Someone who has had a TIA may have only vague symptoms, including high blood pressure, weakness or numbness on one side of the body, changes in motor skills, or confusion. A doctor performing an assessment will look at the patient’s eye movements, pupil reactivity, tongue movement, and shoulder elevation – these all help evaluate the status of the cranial nerves. The doctor will also evaluate attentiveness, language, and other elements of mental status.

A key indicator of carotid stenosis lies in what the doctor hears through the stethoscope when he or she places the stethoscope on the neck alongside the carotid artery. Changes in blood flow in the carotid arteries can be audible, and indicate the need for a more thorough diagnostic workup, including:

• Carotid duplex ultrasound
• Magnetic resonance imaging (MRI) scan
• Computed tomography (CT) scans

These three tests are noninvasive techniques that can reveal evidence of carotid occlusive disease or carotid stenosis. If the tests confirm the presence of a blockage, the patient will probably be referred to a specialist for evaluation. (See Doctors Who Treat Carotid Occlusive Disease.)

Depending on the extent of the stenosis, the treatment plan may begin with medications to treat the underlying causes:

• Antihypertensives for high blood pressure
• Statins or other medication to reduce cholesterol levels and stabilize the atherosclerotic plaque
• Medication to control diabetes

More advanced cases, or individuals whose disease can’t be controlled with medication, will be evaluated for surgical approaches — including carotid endarterectomy, angioplasty, and stenting — to restore healthy blood flow through the artery (see Surgery for Carotid Occlusive Disease).

Carotid occlusive disease is a complex condition, and should be addressed at major centers with experts experienced in its treatment.

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Reviewed by Y. Pierre Gobin, M.D.
Last Reviewed/Updated: September 2020