The carotid and the vertebral arteries supply the brain with oxygenated blood.
A disruption in the blood supply to the brain can cause an ischaemic stroke.
Carotid artery disease occurs when the major arteries in your neck become narrowed or blocked. These arteries, called the carotid arteries, supply your brain with blood. Your carotid arteries extend from your aorta in your chest to the brain inside your skull.
You are more likely to develop carotid artery disease as you age. Only 1 percent of adults age 50 to 59 have significantly narrowed carotid arteries, but 10 percent of adults age 80 to 89 have this problem.
Your arteries are normally smooth and unobstructed on the inside, but as you age, cholesterol plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, your arteries narrow and stiffen. This process is called atherosclerosis, or hardening of the arteries. Eventually, when enough plaque builds up to reduce blood flow through your carotid arteries, physicians call this carotid artery disease. Carotid artery disease is a serious health problem because it can cause a stroke or cerebrovascular incident.
Some plaque deposits are soft and are prone to cracking or forming roughened, irregular areas inside the artery. If this happens, your body will respond as if you were injured and flood the cracked and irregular area with cells called platelets. A large blood clot may then form in your carotid artery or one of its branches. If the clot blocks the artery enough to slow or stop blood and oxygen flow to your brain, it could cause a stroke. More commonly, a piece of the plaque itself, or a clot, breaks off from the plaque deposit and travels through your bloodstream. This particle can then lodge in a smaller artery in your brain and cause a stroke by blocking the artery.
Fortunately, you may be able to prevent or slow carotid artery disease:
Smoking cessation
Diabetes control
Blood pressure control
Cholesterol control
Regular exercising
Healthy diet
Maintaining a healthy weight

Asymptomatic
Carotid artery disease may not cause symptoms in its early stages.
TIAs
Unfortunately, the first sign of carotid artery disease could be a stroke. However, you may experience warning symptoms of a stroke called transient ischaemic attacks, or TIAs. Symptoms of a TIA usually last for a few minutes to 1 hour and 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
<24h
These symptoms usually go away completely within 24 hours. However, you should not ignore them. Having a TIA means that you are at serious risk of a stroke in the near future. You should report TIA symptoms to your physician immediately.
>24h
If you experience the above symptoms for longer than a few hours, or they don't resolve within 24 hours, a stroke has probably occurred. You should contact your physician immediately.
Hardening of the arteries, atherosclerosis, causes most cases of carotid artery disease. Experts do not fully understand the cause of hardening of the arteries. Plaque may build up in the arteries because of an injury to the artery's inner lining. Factors that injure artery walls include smoking, high cholesterol and high blood pressure.
In rare cases, conditions known as carotid aneurysm disease and fibro-muscular dysplasia cause carotid artery disease.
Other factors that may increase your chances of developing carotid artery disease include diabetes and having a family history of hardening of the arteries.
History
First your physician asks you questions about your general health, medical history and symptoms.
Physical Examination
In addition, your physician conducts a physical exam.
During your exam, your physician will listen for sounds of turbulent blood flow in your carotid arteries. He or she may also measure your blood pressure.
Carotid Ultrasound
In this test, a technician holds a small ultrasound probe to your neck. The probe emits high-frequency sound waves that bounce off of blood cells and blood vessels to show blood flow and problems with the structure of blood vessels. This test can show your physician how open your carotid arteries are and how quickly blood flows through them. Carotid duplex ultrasound detects most cases of carotid artery disease.
Computed Tomography (CT) scan
CT scans take x-ray pictures of slices of the brain. CT scans can indicate carotid artery disease by showing an area of the brain that has poor blood flow. Your physician may inject a contrast dye to make blood vessels appear on the x-ray
Magnetic resonance angiography (MRA)
MRA uses radio waves and magnetic fields to create detailed images. Some forms of this test can show moving blood flow and may help evaluate carotid artery disease. To improve the test's accuracy, physicians sometimes inject a material called gadolinium to make the arteries more visible
Angiography
In this test, a contrast dye is injected into your arteries and then takes x-rays. The structure of your arteries appears on the x-ray because x-rays cannot pass through the dye. This test shows how blood flows through the arteries and whether they are narrowed. Angiography carries some risks, including a small incidence of stroke
Smoking cessation
Diabetes control
Blood pressure control
Cholesterol control
Regular exercising
Healthy diet
Maintaining a healthy weight
Statins
Antiplatelet drugs
Indications
TIA symptoms + > 70% stenosis
No symptoms + >90% stenosis
Technique
During surgery, Dr Weir removes plaque that is blocking your carotid artery. The procedure is called a carotid endarterectomy. Dr Weir makes an incision in your neck and then removes the plaque contained in the inner lining of your carotid artery. This procedure removes the plaque and leaves a smooth, wide-open artery. You may be able to leave the hospital a day or two after the procedure depending upon how you feel. This procedure is safe and long lasting.
While I do not perform stenting, it is important you understand why. Angioplasty and stenting is a minimally invasive procedure. To perform this procedure, a long, thin tube called a catheter is inserted through a small puncture site over a groin artery and guide it through the blood vessels to the carotid artery. The catheter carries a tiny balloon that inflates and deflates, flattening the plaque against the walls of the artery. A tiny metal-mesh tube called a stent is placed in the artery to hold it open.
Due to the higher incidence of associated ischaemic stroke, this practice does not perform carotid stent procedures

If you do not require surgery, make sure you and your immediate family members understand the warning signs of a transient ischaemic attack (TIA). These include weakness of an arm and a leg on the same side, temporary blindness of one eye and / or a temporary inability to speak. Follow Dr Weir’s instructions for any prescribed medications, and return for any scheduled follow up tests.
Changing some lifestyle factors, especially smoking, may limit the progression of your carotid artery disease. The first step smokers should take is to quit smoking. Other changes that can decrease your risk of carotid artery disease include losing weight, exercising regularly, and eating a diet low in saturated fats.
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.
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.
Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria