Carotid Stenosis: How to Prevent Stroke Before It Happens

The carotid arteries are the two major blood vessels on either side of your neck that supply the brain and face with oxygenated blood. When atherosclerotic plaque builds up inside these arteries, it causes carotid stenosis — narrowing that is responsible for approximately 20% of all ischaemic strokes. The critical fact is that most people with significant carotid stenosis have no symptoms until a stroke or TIA (transient ischaemic attack) occurs. This makes proactive screening and early intervention life-saving.

Risk Factors for Carotid Stenosis

• Smoking: Accelerates atherosclerosis and is the single most modifiable risk factor
• Hypertension: Sustained high blood pressure damages the arterial wall, promoting plaque formation
• Diabetes mellitus: Accelerated arterial wall disease and plaque instability
• High LDL cholesterol: Directly contributes to plaque volume and inflammation
• Age over 65: Prevalence increases sharply with age
• Family history of stroke or arterial disease
• Coronary artery disease: Indicates systemic atherosclerosis — if coronaries are affected, carotids should be assessed

Warning Signs You Must Not Ignore (TIA)

A transient ischaemic attack (TIA) — sometimes called a mini-stroke — lasts minutes to hours and fully resolves. However, it is a medical emergency because up to 10% of TIA patients will have a full stroke within 48 hours. Recognise the FAST signs:

• Face drooping — one side of the face falls
• Arm weakness — inability to raise one arm
• Speech difficulty — slurred or incomprehensible speech
• Time — call emergency services immediately

Other symptoms include sudden loss of vision in one eye (amaurosis fugax), sudden severe headache, and sudden confusion or loss of coordination.

Diagnosis: Carotid Doppler Ultrasound

Carotid Doppler duplex ultrasound is the first-line investigation. It is painless, radiation-free, and performed at Dr. Haggag's clinic in Heliopolis. The scan measures the degree of stenosis at the carotid bifurcation (the most common site of plaque), characterises plaque morphology (stable vs. vulnerable), and measures intima-media thickness. Stenosis is graded by percentage: mild (<50%), moderate (50–69%), severe (70–99%), or occlusion (100%).

CT angiography or MR angiography may be ordered to confirm findings before surgical planning.

Treatment Options

• Medical management: Antiplatelet therapy (aspirin or clopidogrel), statins, blood pressure control, and smoking cessation for mild to moderate stenosis
• Carotid endarterectomy (CEA): The gold-standard operation for symptomatic stenosis ≥50% or asymptomatic stenosis ≥70%. Plaque is surgically removed under anaesthesia.
• Carotid artery stenting (CAS): A minimally invasive catheter-based alternative. Preferred in patients with high surgical risk, previous neck surgery, or radiation.