Understanding Carotid Artery Disease: What You Need to Know when you are are diagnosed
The Cleveland Clinic Department of Vascular Surgery is a high volume quaternary surgery center of excellence located in Northeast Ohio and providing service to Cleveland, Youngstown, Columbus, Toledo, Indiana, Michigan, Pennsylvania
Carotid artery disease—also called carotid stenosis—means that one or both of the arteries in your neck that carry blood to your brain have become narrowed by cholesterol plaque. This narrowing can raise the risk of stroke. The good news is that with early detection, good medical care, and careful decision-making, many strokes can be prevented.
This guide is written to help patients and families understand what carotid disease is, how it is found, how it is treated, and what to expect if surgery is recommended.
Chapter 1 — Risk Factors: Who Is at Risk?
Carotid disease develops slowly over time. It is caused by the same process that leads to heart disease and blockages in the legs.
You are more likely to have carotid disease if you have one or more of these risk factors:
Age 65 or older
High blood pressure
High cholesterol
Diabetes
Current or past smoking
Obesity or little physical activity
Kidney disease
A history of heart attack or stroke
A family history of early heart disease or stroke
Many people with carotid disease feel perfectly fine. You often do not have symptoms until the artery becomes very narrow or a stroke occurs. That is why screening and prevention matter so much.
Chapter 2 — Diagnostic Tools: How Is Carotid Disease Found?
Doctors use simple and safe tests to look at your carotid arteries.
The most common test is:
Carotid ultrasound
Painless
No radiation
Uses sound waves to show how narrow the artery is
Can be done in an office or hospital
If more detail is needed, your doctor may order:
CT scan (CTA) of the neck
MRI (MRA) of the neck
These tests help your doctor see the exact location and severity of the blockage and plan treatment if needed.
Chapter 3 — Medical Management: First-Line Treatment for Many Patients
For many people with carotid stenosis, medicine and lifestyle changes are the safest and best treatment.
Typical medical management includes:
Cholesterol medicine (statin) to slow plaque growth
Blood pressure control
Aspirin or another blood thinner (if recommended)
Diabetes control
Smoking cessation
Healthy diet and regular walking
Modern medical therapy is very effective. Recent studies show that for many patients—especially those without symptoms—the yearly risk of stroke with good medical care is low (around 1–2% per year).
This means that not everyone with a narrowed carotid artery needs surgery.
Chapter 4 — Indications for Surgery: When Is an Operation Needed?
Surgery is considered when the risk of stroke is higher than the risk of the operation.
In general, doctors think about surgery when:
You had symptoms (such as a mini-stroke or TIA) and the artery is significantly narrowed
You have a severe blockage (usually 70% or more) even without symptoms, and you are a good surgical candidate
Two main procedures may be discussed:
Carotid endarterectomy (CEA) Watch a CEA
An open surgery in which plaque is removed from the artery
Often the preferred option for many patients
Carotid stenting (CAS)
A less invasive procedure using a stent
May be chosen for certain high-risk surgical patients
The right choice depends on your age, anatomy, medical conditions, and overall health.
Chapter 5 — Questions About Recovery and Return to Work
If surgery is recommended, it is important to understand what recovery looks like. Here are good questions to ask your surgeon:
Before the procedure
What is my personal risk of stroke with surgery?
What is my risk if I choose medical therapy only?
Which procedure is best for me—surgery or stent—and why?
After the procedure
How long will I stay in the hospital?
(Often 1 night for carotid endarterectomy.)
When can I shower?
When can I drive?
When can I walk normally again?
Return to work
Desk job: often 1–2 weeks
Light physical work: often 2–3 weeks
Heavy labor: often 4–6 weeks
Your recovery may be faster or slower depending on your health and the type of procedure.
A Final Message of Hope
Carotid artery disease is serious—but it is also treatable and often preventable. With the right mix of medical therapy, careful monitoring, and surgery when truly needed, most patients can live full, active lives while lowering their risk of stroke.
If you have risk factors or a family history of stroke, ask your doctor about a carotid ultrasound. Early knowledge gives you the power to protect your brain and your future.
If you would like, I can:
Turn this into a one-page printable PDF
Add simple diagrams or graphics
Create a patient checklist or infographic
Adapt it specifically for a Cleveland Clinic website or brochure
Just tell me how you’d like to use it.
Here is a check list for you to understand the questions that you should ask:
Below is a clear, patient-friendly checklist you can place at the end of your blog, use as a handout in clinic, or share at community events. It is written at an 8th–9th grade reading level and aligns with the structure of your carotid stenosis post.
Carotid Artery Disease: Patient Checklist
Use this checklist to understand your risk, know when to get tested, and prepare for conversations with your doctor.
✅ 1) Do I have risk factors? (Check all that apply)
You may be at higher risk for carotid disease if you have any of the following:
☐ Age 65 or older
☐ High blood pressure
☐ High cholesterol
☐ Diabetes
☐ Current or past smoker
☐ Little physical activity
☐ Obesity
☐ Kidney disease
☐ Prior heart attack, stroke, or TIA (“mini-stroke”)
☐ Family history of early stroke or heart disease
If you checked 2 or more boxes → Ask your doctor about carotid screening.
✅ 2) Have I had warning symptoms? (Urgent signs)
Seek medical care right away if you ever had:
☐ Sudden weakness or numbness on one side of your body
☐ Trouble speaking or understanding speech
☐ Sudden loss of vision in one eye
☐ Sudden dizziness or loss of balance
☐ Symptoms that came and went within minutes (possible TIA)
👉 These can be signs of a stroke or TIA and require urgent evaluation.
✅ 3) Have I had the right tests? Ask your clinician about:
☐ Carotid ultrasound (first test for most patients)
☐ CT scan (CTA) of the neck (if more detail is needed)
☐ MRI (MRA) of the neck (if more detail is needed)
Ask:
“How narrowed is my carotid artery in percent (%)?”
✅ 4) Am I on the right medical therapy?
Ask your doctor whether you should be on:
☐ Cholesterol medicine (statin)
☐ Blood pressure medicine (if needed)
☐ Aspirin or another blood thinner (if recommended)
☐ Diabetes medicine (if needed)
☐ A smoking-cessation plan (if you smoke)
You can say:
“What is my plan to lower my stroke risk even if I don’t need surgery?”
✅ 5) Do I need surgery—or not? Important questions to ask
If you are told you have carotid narrowing, ask:
“Do I have symptoms or am I asymptomatic?”
“What is my stroke risk with medical therapy alone?”
“What is my stroke risk with surgery or stenting?”
“Which option is best for my age, anatomy, and health—and why?”
“What are your personal outcomes with this procedure?”
✅ 6) If surgery is recommended, ask about recovery
☐ How long will I be in the hospital?
☐ When can I shower?
☐ When can I drive?
☐ When can I return to work?
Typical ranges (may vary):
Desk job: 1–2 weeks
Light physical work: 2–3 weeks
Heavy labor: 4–6 weeks
✅ 7) Red flags after treatment — call your doctor if these occur
☐ New weakness or numbness
☐ Trouble speaking
☐ Severe headache
☐ Vision problems
☐ Worsening neck swelling or pain
Bottom line for patients
Most people with carotid disease do not need surgery. Many do very well with medicine and lifestyle changes. Surgery is reserved for people who are most likely to benefit.
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