Stroke & Carotid Artery Disease
Reviewed by Dr Amit KumarCarotid endarterectomy
Spotting a TIA — the warning that shouldn't wait
Why a brief 'mini-stroke' is an urgent warning, and what to do about it.
Medical terms
Tap a term for a plain-English definition.
What is this
The carotid arteries run up either side of the neck and supply blood to the front half of the brain. Similarly, the back half of the brain is fed by blood vessels in the back of the neck (vertebral arteries), and these too can have blockages and cause a stroke.
Carotid artery disease is a narrowing of these arteries, usually from a build-up of fatty plaque. A fragment of plaque or a clot can break off and travel to the brain, causing a transient ischaemic attack (a 'mini-stroke', or TIA) or a stroke.
Symptoms
Carotid narrowing itself is usually silent. The symptoms that matter are those of a TIA or stroke — often sudden and painless:
- Sudden drooping on one side of the face
- Sudden weakness or numbness in an arm or leg, usually on one side
- Sudden difficulty speaking or understanding speech
- Sudden loss or blurring of vision, usually in one eye
- Sudden severe dizziness or loss of balance
TIA symptoms may last only minutes and then resolve — but a TIA is a serious warning and must never be ignored.
The most important section
When to seek an opinion
Stroke is a time critical emergency.
- Remember FAST — Face, Arms, Speech, Time to call for help: Face dropping on one side, an arm that cannot be held up, or slurred or muddled speech — call emergency services immediately
- Any of the symptoms above, even if they pass quickly (a TIA) — this needs urgent same-day medical assessment
- Sudden loss of vision in one eye
Who gets them, and why
The risk factors are the familiar ones for artery disease: age, smoking, high blood pressure, diabetes and high cholesterol. Carotid narrowing is often silent until a warning event occurs.
How it’s assessed
It is usually found after a TIA or stroke, or when a doctor hears a sound (a bruit) over the neck. The main test is a duplex ultrasound of the neck, sometimes with a CT or MRI scan.
More about the scans you might have is on the Tests page.
Treatment options
For most people, the aim is to reduce the risk of a first or further stroke by treating the underlying artery disease. When a carotid artery is significantly narrowed — particularly after a TIA or stroke — a procedure may substantially reduce the risk of a further stroke.
Start here — conservative measures
Stop smoking and manage risk factors
Controlling blood pressure, diabetes and cholesterol, and stopping smoking, are the foundation of lowering stroke risk.
- What it involves:
- Usually managed with your GP alongside lifestyle changes.
Medication
A statin to stabilise plaque and an antiplatelet medicine (such as aspirin or clopidogrel) to reduce clotting are commonly used.
- What it involves:
- Prescribed and reviewed by your doctor.
Procedures, if they are needed
Carotid endarterectomy
Watch: Carotid endarterectomyAn operation to open the artery in the neck and remove the plaque.
- What it involves:
- This usually requires a long cut on the side of the neck to find and clean the blockages.
Carotid stenting
A stent is placed to hold the narrowed artery open, done from inside the artery.
- What it involves:
- An alternative for selected patients; suitability depends on your anatomy and health.
Whether a procedure helps depends on how narrow the artery is, whether it has already caused symptoms, and your overall health — it is a careful, individual decision.
What happens if they’re left untreated
Narrowing that has already caused a warning event (a TIA) carries a raised risk of a full stroke, particularly in the days and weeks that follow — which is why prompt assessment matters. Narrowing that has never caused symptoms is usually watched and managed with medication and risk-factor control.
Common Questions Patients Ask
What is a TIA?+
A transient ischaemic attack is a 'mini-stroke' — stroke-like symptoms that resolve, usually within minutes to hours. It causes no lasting damage itself, but it is a strong warning that a full stroke could follow, so it needs urgent assessment.
Does carotid narrowing always cause a stroke?+
No. Many people have some narrowing that never causes a problem. The risk depends on how severe it is and whether it has already caused symptoms — which is what guides treatment.
Can I lower my risk?+
Yes — stopping smoking and controlling blood pressure, diabetes and cholesterol make a real difference, alongside any medication your doctor prescribes.
Is the operation on the brain?+
No — carotid surgery is on the artery in the neck, not the brain itself. Its purpose is to remove the source of blockages before they can reach the brain.
What is my life after surgery / stent if done in time?+
Your return to the same state (provided no complications from the procedure) within 2 - 4 weeks (sooner for most). Remember the procedure is not meant to reverse a stroke, but to prevent a new stroke / TIA from occurring.
What is my follow up like?+
You will need to be assessed after 1 month, 3 months, 6 months and annually after the stent or the operation to check that the repair continues to remain successful and to ensure that the other vessels are not developing similar blockages.
Contact us
To ask about stroke & carotid artery disease or arrange an assessment, send the clinic a message on WhatsApp.