CAROTID
The carotid arteries in your neck carry blood to your brain. If the supply is cut off, it can cause a stroke.
Carotid Artery Stenosis
Carotid artery disease is a narrowing of the arteries in your neck that carry blood to your brain. It happens when a fatty deposit called plaque builds up inside the artery wall – a process called atherosclerosis, or hardening of the arteries. It becomes more common as you get older.
It matters because it can cause a stroke. A piece of plaque or a blood clot can break off, travel to the brain and block a smaller artery; or the narrowed artery itself can close off. Either way, part of the brain loses its blood supply.
You can lower your risk:
Don't smoke
Control diabetes, blood pressure and cholesterol
Exercise regularly
Eat a healthy diet
Keep to a healthy weight
Symptoms
Often there are no symptoms
Early on, carotid artery disease usually causes no symptoms.
Warning signs – a mini-stroke (TIA)
Sometimes the first warning is a mini-stroke, or transient ischaemic attack (TIA) – brief stroke-like symptoms that may include:
Feeling weakness, numbness, or a tingling sensation on one side of your body, for example, in an arm or a leg
Being unable to control the movement of an arm or a leg
Losing vision in one eye (many people describe this sensation as a window shade coming down)
Being unable to speak clearly
A TIA is a warning, not an all-clear
Even when the symptoms pass completely, about one in three mini-strokes have already caused a small area of brain injury. A TIA means you are at high risk of a full stroke in the days that follow.
Treat it as an emergency
Any sudden weakness, numbness, loss of vision or difficulty speaking – whether it lasts seconds or longer – needs emergency medical attention straight away. Don't wait to see if it passes.
Causes
Most carotid artery disease is caused by atherosclerosis (hardening of the arteries). The main things that damage the artery walls are smoking, high cholesterol and high blood pressure. Diabetes and a family history also raise your risk.
Less often, the narrowing is caused by other conditions, such as fibromuscular dysplasia, previous radiation to the neck, or a tear in the artery wall (dissection).
Tests
History and examination
I ask about your health, medical history and symptoms, and listen over the arteries in your neck for the sound of disturbed blood flow.
Carotid ultrasound (duplex)
A quick, painless scan of your neck that shows how narrowed the arteries are and how well blood flows through them. This is the main test and picks up most cases.
CT angiogram (CTA)
A CT scan with contrast dye that gives a detailed picture of the carotid arteries and pinpoints any narrowing. A plain CT can also show areas of previous stroke.
MRA (MRI angiogram)
Uses a magnetic field instead of x-rays to image the arteries and blood flow.
Angiography
Dye is injected directly into the arteries and x-rays are taken. It gives the most detailed pictures but carries a small risk of stroke, so it is used only when needed.
Treatment Options
Optimal Medical Therapy
Smoking cessation
Diabetes control
Blood pressure control
Cholesterol control
Regular exercising
Healthy diet
Maintaining a healthy weight
Statins
Antiplatelet drugs
Surgery
When surgery is advised
If you have had symptoms (a mini-stroke/TIA, a minor stroke, or brief loss of vision in one eye) and the artery is more than 50% narrowed, surgery is advised – and should be done urgently, ideally within two weeks.
If you have no symptoms, I take a deliberately cautious approach and only operate on severe (more than 90%) narrowing, because modern medication now controls milder narrowing well.
The operation (carotid endarterectomy)
I make a small incision in your neck and remove the plaque from the lining of the artery, leaving it smooth and open again. Most people go home a day or two later. The operation is generally safe and its results are long-lasting.
Endovascular Repair
Why I don't offer stenting
Stenting is a less invasive option: a thin tube (catheter) is passed from an artery in the groin up to the carotid, where a small balloon flattens the plaque and a metal mesh tube (stent) holds the artery open. However, because carotid stenting carries a higher risk of stroke during the procedure, this practice does not perform it.
References
European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg, 2023.
Society for Vascular Surgery (SVS) 2022 Clinical Practice Guidelines for Management of Extracranial Cerebrovascular Disease. J Vasc Surg, 2022.
Carotid Endarterectomy
General Guidelines
If you don't need surgery, make sure you and your family know the warning signs of a mini-stroke (TIA): weakness of an arm and leg on one side, brief loss of vision in one eye, or sudden difficulty speaking. Take your medications as prescribed and keep your follow-up appointments.
Lifestyle changes slow the disease. Stopping smoking is the most important step. Losing weight, exercising regularly and eating a low-fat diet also help.
If you have any problems with any of these conditions, please contact your General Practitioner, or your Vascular Surgeon. If you live in Pretoria and have not seen a Vascular Surgeon before, you are more than welcome to contact my rooms for a formal consultation.
Gregory Weir Vascular Surgery
The purpose of this web site is to offer Dr Weir’s patients and their families access to information regarding vascular disease in general as well as specific information on certain disease processes. The information on this site does not necessarily apply to all patients with the same diagnosis. If you are not a patient of Dr Weir, please do not regard the information on this website as a substitute for a thorough assessment by a qualified Vascular Surgeon. If in doubt, consult your doctor.
If you are experiencing a medical emergency, phone us. If you are not able to get through or if we are not available, please visit your nearest casualty department.
Consultation Rooms
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria
Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.