Q. During a recent appointment, my cardiologist heard a sound in my neck and sent me for an ultrasound, which showed a narrowing in my carotid artery. The doctor said this means I’m at risk for a stroke. Because I’m already taking all the right medicines, his only recommendation was getting another ultrasound in a year. But if the narrowing gets worse and I have a stroke, won’t that be too late?
A. The carotid arteries, found on either side of the neck, are the main supply route for blood to reach the brain. If cholesterol-laden plaque clogs one of these arteries, it sometimes produces a distinctive sound (called a bruit [BROO-ee]) that a doctor can detect with a stethoscope. That finding usually prompts an ultrasound.
A narrowed carotid artery (also called carotid artery stenosis) can increase the risk of stroke—the narrower the artery, the higher the risk. Occasionally, the narrowing itself causes problems by restricting blood flow. But the bigger danger is when a piece of plaque breaks off or a blood clot forms in the narrowed area, leading to a stroke.
Doctors sometimes treat carotid artery stenosis with surgery or placement of a stent, a tiny metal coil to prop up the artery. But these procedures can trigger a stroke. In the absence of symptoms, doctors don’t usually recommend such treatment unless your carotid artery is blocked by more than 70%. For people with less serious narrowing, getting regular ultrasounds to check for any possible progression and taking medications to counter further narrowing is a common practice. For them, the risk of stroke caused by the procedure might outweigh the benefits.?
— Deepak L. Bhatt, MD, MPH
Editor in Chief, Harvard Heart Letter