Cervical Internal Carotid Artery Stenosis

The carotid arteries are paired major arteries that branch off the aorta near the heart and supply blood to the face, neck, and brain. Near the region where the back of the jaw and neck meet, the carotid arteries branch into an external carotid artery (ECA) that supplies blood to the face and neck and an internal carotid artery (ICA) that supplies blood to the brain.

The portion of the ICA in the neck just past the branch up to where it penetrates the skull and enters into the brain is known as the cervical or neck ICA (sometimes also called the extracranial ICA) and is the most common region to build up fatty plaques. That plaque build-up results in stenosis (or narrowing) of the artery, which limits the supply of blood to the brain and can cause blood clots to form. If the clot travels to your brain, it causes a stroke.

When discussing ICA stenosis with your physician, it is important that you know your degree of ICA stenosis. Degrees of ICA stenosis is usually given as a percentage. Major medical studies have shown that the degree percentage is the most important piece of information in determining the best way to treat your ICA stenosis.

Cervical ICA stenosis is often diagnosed after a patient experiences dizziness (vertigo), abrupt vision changes, passing out (syncope), weakness or numbness on one side of the body, other stroke-like symptoms, or if a physician hears a bruit — a sound heard by a physician after placing a stethoscope on the neck over the carotid artery — during a routine physical exam.

Common imaging tests to evaluate and diagnose ICA stenosis include specialized tests called computed tomography angiography (CTA), magnetic resonance (MR) angiography (MRA) and duplex carotid ultrasound. These tests are not invasive and are excellent screening tools to determine whether or not a patient has ICA stenosis. CTA, MRA, and ultrasound are good screening tools and offer an initial assessment of stenosis severity, but the gold standard test is digital subtraction cervicocerebral angiography.

Treatment options include medical management, open surgical carotid endarterectomy and minimally invasive catheter based carotid angioplasty and stenting. In addition to percent stenosis, treatment recommendations are also dependent upon other factors including exact location and length of stenosis, presence or absence of stroke or transient ischemic attack (TIA) symptoms (symptomatic or asymptomatic), age, sex, history of prior neck surgery, and other medical and/or surgical conditions.