The carotid arteries, which carry blood to the brain, are located on the left and right sides of the front of the neck. Carotid artery disease (hardening of the arteries, atherosclerosis) occurs when the artery becomes clogged with fatty deposits (atherosclerotic plaque). Fatty deposits can narrow the artery so severely that not enough blood can get through to the brain, or a piece of the atherosclerosis may break off and travel with the flowing blood to the brain. Either way a stroke could occur.

As many as 75 percent of people who suffer a stroke related to carotid artery disease have a warning, or transient ischemic attack (TIA), before the stroke. A TIA is a temporary neurologic deficit (e.g., weakness, numbness, difficulty speaking) that lasts less than 24 hours and from which the patient completely recovers.

If the deficit lasts longer than 24 hours but full recovery still occurs, it is called a reversible ischemic neurologic deficit, or RIND. If the TIA only affects vision, causing temporary loss of vision or graying out of the vision in just one eye, it is called amaurosis fugax. Carotid artery disease is just one possible cause of TIAs.

Treatment Options

Carotid Endarterectomy

The most common treatment for carotid artery disease is carotid endarterectomy. During a carotid endarterectomy an incision is made along the front of the neck and the carotid artery is then opened and the atherosclerosis is removed. The artery is repaired with either sutures or a graft. This may be done using either local or general anesthesia. Either way, most patients are discharged from the hospital within 48 hours of undergoing the operation.

For some patients, direct surgical repair via a carotid endarterectomy is not a very good option. This may be because of the location of the stenosis (narrowing), or the patient's overall health may make surgery too risky.

Carotid Angioplasty

Carotid angioplasty and stenting, a relatively new procedure, shows promise in the treatment of carotid artery disease for patients who may not be in good enough health to undergo surgery -- such as people with severe heart or lung disease, those who have had neck operations or radiation for neck tumors, and those who have already had carotid endarterectomies.

In carotid angioplasty, a balloon is attached to a catheter -- a long tube -- that is inserted in the groin artery and threaded through the arteries to the narrowed carotid artery. The balloon at the end of the catheter is inflated to open the narrowed area, and a metal stent, which is a kind of wire mesh tube, is left in place to keep the artery from narrowing again.

Patients are awake during the procedure, and are usually discharged from the hospital the following day. Most patients are able to resume normal activities when they get home.