Carotid Artery Stenosis: Symptoms, Risks, and Management

Q: Carotid Artery Stenosis: Symptoms, Risks, and Management

Hello： If there is only vascular stenosis without any cerebral infarction lesions, it is recommended to manage risk factors such as blood pressure, blood sugar, and lipid levels, and to follow up at a neurology outpatient clinic.

Carotid artery stenosis?

Hello Doctor, this month I underwent an MRI due to a pituitary tumor issue, and the report included a finding related to the carotid artery.
When I inquired about the report, the doctor mentioned that it was just a narrowing and that the risk of stroke was slightly higher, but there was no need for follow-up or medication.
However, I often experience dizziness, occasional weakness, and sometimes I feel that my tongue is not very agile when speaking, along with intermittent swallowing difficulties.
Since the doctor kept saying there was nothing to worry about during the consultation, I hesitated to ask further questions.
Could these issues possibly be related to the narrowing? Also, how severe is the degree of stenosis indicated in the report? Are there any precautions I should take? Additionally, would you recommend regular follow-ups? I apologize for the many questions, and I appreciate your willingness to take the time to respond.
Thank you, and I wish you all the best.
The 3D TOF MRA of the Circle of Willis revealed moderate stenosis at the C5 and C6 levels of the right internal carotid artery.

haru, 20~29 year old female. Ask Date: 2020/12/01

Dr. Cai Zongzhang reply Neurology

Hello: If there is only vascular stenosis without any cerebral infarction lesions, it is recommended to manage risk factors such as blood pressure, blood sugar, and lipid levels, and to follow up at a neurology outpatient clinic.

Reply Date: 2020/12/01

More Info

Understanding carotid artery stenosis is crucial, especially when it comes to recognizing its symptoms, associated risks, and management strategies. Carotid artery stenosis refers to the narrowing of the carotid arteries, which supply blood to the brain. This condition can lead to serious complications, including an increased risk of stroke.

Symptoms of Carotid Artery Stenosis
Many individuals with carotid artery stenosis may not experience any symptoms, especially in the early stages. However, as the condition progresses, symptoms can manifest. Common symptoms include:
1. Transient Ischemic Attacks (TIAs): These are temporary episodes of neurological dysfunction caused by a lack of blood flow to the brain. Symptoms may include sudden weakness, numbness, difficulty speaking, or vision problems. TIAs are often warning signs of a potential stroke.

2. Stroke Symptoms: If the stenosis is severe and leads to a stroke, symptoms can include sudden confusion, trouble speaking or understanding speech, paralysis or numbness of the face, arm, or leg, especially on one side of the body, and difficulty walking.

3. Dizziness and Weakness: As you mentioned experiencing dizziness and occasional weakness, these could be related to reduced blood flow to the brain due to stenosis.
4. Difficulty Swallowing and Speech Issues: The sensations of your tongue feeling less agile and swallowing difficulties could also be linked to neurological effects from reduced blood flow.

Risks Associated with Carotid Artery Stenosis
The primary risk associated with carotid artery stenosis is stroke. The degree of stenosis is a significant factor in determining stroke risk; moderate stenosis (typically defined as 50-69% narrowing) can increase the risk of stroke, particularly if other risk factors are present, such as hypertension, diabetes, or a history of cardiovascular disease.

Management of Carotid Artery Stenosis
Management strategies for carotid artery stenosis depend on the severity of the condition and the presence of symptoms:
1. Lifestyle Modifications: Patients are often advised to adopt heart-healthy lifestyle changes, including a balanced diet, regular exercise, smoking cessation, and weight management.

2. Medications: While your doctor may have indicated that medication is not necessary at this time, it is common for patients with carotid artery stenosis to be prescribed antiplatelet agents (like aspirin) to reduce the risk of stroke. Statins may also be recommended to manage cholesterol levels.

3. Monitoring: Regular follow-up appointments are essential to monitor the progression of the stenosis. Your doctor may recommend periodic imaging studies, such as ultrasound or MRI, to assess the degree of narrowing.

4. Surgical Interventions: In cases of severe stenosis (typically over 70% narrowing) or if symptoms are present, surgical options such as carotid endarterectomy or carotid artery stenting may be considered to restore normal blood flow.

Recommendations for Your Situation
Given your symptoms of dizziness, occasional weakness, and difficulties with speech and swallowing, it is essential to communicate these concerns clearly with your healthcare provider. While your doctor may have downplayed the severity of the stenosis, your symptoms warrant further evaluation. It is advisable to seek a second opinion or request a referral to a vascular specialist for a comprehensive assessment.

In terms of the severity of the stenosis, moderate stenosis at the C5 and C6 levels of the right internal carotid artery (ICA) indicates that there is a significant narrowing that could potentially impact blood flow. While it may not be classified as severe, it is still a cause for concern, especially in the context of your symptoms.

Conclusion
In summary, carotid artery stenosis can pose significant risks, particularly regarding stroke. Your symptoms should not be overlooked, and it is crucial to have an open dialogue with your healthcare provider about your concerns. Regular monitoring and appropriate management strategies can help mitigate risks and improve your overall health outcomes. If you feel your concerns are not being adequately addressed, do not hesitate to seek further evaluation or a second opinion.

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