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JAMA Patient Page
January 13, 2015

Testing for Carotid Stenosis

JAMA. 2015;313(2):212. doi:10.1001/jama.2014.16392

Carotid stenosis, also called carotid artery disease, refers to narrowing of the major blood vessels in the neck, which can sometimes lead to stroke.

What Is Carotid Stenosis?

The internal carotid arteries are 2 major blood vessels (one on each side of the neck) that deliver blood to the brain. Just like the coronary arteries of the heart, the carotid arteries can become unhealthy when there is a buildup of plaque (a collection of cholesterol, calcium, and other materials) inside them. This plaque buildup causes a narrowing of the blood vessels, called stenosis. Over time, this narrowing can lead to problems with the blood supply to the brain, which can result in a stroke.

Conditions that increase one’s risk of having carotid stenosis are smoking, diabetes, high cholesterol, and high blood pressure.

Who Should Be Tested for Carotid Stenosis?

Testing for carotid stenosis is recommended in people who have had a stroke and sometimes in people who have episodes of stroke-like symptoms. These symptoms include changes in vision in one eye, weakness or numbness on one side of the face or body, or difficulty speaking. The goal of testing for carotid stenosis in these people is to lower their chance of having another stroke. This can be done with medications to lower cholesterol and blood pressure or medications to lower the chance of blood clots, such as aspirin. In some people with severe narrowing, certain surgical procedures can be performed to remove the plaque or open up the artery.

What Kinds of Tests Are Available?

Three types of imaging tests can be used to look for carotid stenosis: ultrasound, magnetic resonance angiography, or computed tomographic angiography. A more invasive test not commonly used is cerebral angiography, which involves a catheter (a flexible tube) inserted directly inside the blood vessels of the brain.

In most people, carotid stenosis does not cause any symptoms. For the general population, there has not been enough evidence from scientific studies to prove that testing for carotid stenosis in people without symptoms is beneficial. The US Preventive Services Task Force does not currently recommend testing for carotid stenosis in the general population. But in certain populations, it might be useful to test for carotid stenosis when there are no symptoms. An example of a special case is someone who is about to have surgery and who is known to have poor blood flow through other blood vessels in the body, in particular the coronary arteries of the heart. In this case, testing for carotid stenosis before surgery may be recommended. A JAMA Clinical Guidelines Synopsis article in the January 13, 2015, issue of JAMA summarizes the most up-to-date evidence on this topic.

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Article Information

Sources: Jonas DE, Feltner C, Amick HR, et al. Screening for asymptomatic carotid artery stenosis: a systematic review and meta-analysis for the US Preventive Services Task Force. Ann Intern Med. 2014;161(5):336-346.

Beckman JA. Management of asymptomatic internal carotid artery stenosis. JAMA. 2013;310(15):1612-1618.

Topic: Cardiovascular Disease