Your carotid arteries are the two major blood vessels on either side of your neck that carry oxygenated blood from your heart to your brain. When fatty deposits — called plaque — accumulate inside these arteries, the vessels narrow and stiffen. This condition, known as carotid artery disease or carotid artery stenosis, is responsible for approximately 10 to 15 percent of all ischemic strokes.
Why It Is Called "Silent"
Carotid artery disease rarely causes pain or obvious symptoms in its early stages. Plaque builds up silently over decades, gradually reducing blood flow or creating an environment where clots can form. For many people, the first sign of a problem is a transient ischemic attack (TIA — sometimes called a mini-stroke) or a full stroke.
Warning signs of a TIA or stroke include sudden facial drooping, arm weakness, slurred speech, or vision loss in one eye. These require immediate emergency evaluation. Call 911.
Risk Factors for Carotid Artery Disease
The same lifestyle factors that damage blood vessels throughout the body accelerate carotid plaque formation.
- —High blood pressure (hypertension) — the single strongest modifiable risk factor
- —High LDL ("bad") cholesterol
- —Diabetes mellitus
- —Smoking — even former smokers remain at elevated risk
- —Obesity and physical inactivity
- —Age over 65
- —Male sex (though women's risk rises sharply after menopause)
- —Family history of stroke or heart disease
- —Prior history of TIA or stroke
- —Coronary artery disease or peripheral artery disease
How Carotid Artery Disease Is Detected
A carotid duplex ultrasound is the primary screening and diagnostic tool for carotid artery disease. It is non-invasive, uses no radiation, and takes approximately 30 minutes. The exam produces two types of information: a B-mode image showing the anatomy of the artery wall, and Doppler measurements showing blood flow velocity.
Together, these measurements tell your physician how much plaque is present, how significantly the artery is narrowed (stenosis percentage), and whether the plaque has characteristics that make it higher-risk for causing a clot or stroke.
What the Results Mean
- —Less than 50% stenosis: mild narrowing — managed with medications and lifestyle changes
- —50–69% stenosis: moderate narrowing — close monitoring; medication adjustment may be warranted
- —70% or greater stenosis: severe narrowing — may warrant surgical intervention (carotid endarterectomy or stenting)
- —Near-occlusion or occlusion: emergency evaluation needed
Who Should Be Screened?
Routine population-wide screening is not currently recommended for asymptomatic individuals. However, targeted screening is strongly considered for people with multiple vascular risk factors, those who have had a TIA, and patients referred by a physician after hearing an abnormal sound (bruit) over the neck during a physical exam.
If you have experienced dizziness, vision changes, or one-sided weakness — even briefly — a carotid duplex is an important part of the workup to determine stroke risk.
Carotid artery duplex scans are available at Heartwell STAT Imaging with same-day results. If your doctor has ordered this test or you have risk factors for stroke, no long wait is necessary.