This simple, painless and fast procedure provides a 'window' to the condition of major arteries and the coronary circulation. Early changes in the arterial lining can reveal the presence of cardiovascular disease before it produces symptoms. Armed with this information, it is possible to undertake clear lifestyle choices or to seek preventative therapy in the form of lipid lowering medication or anti-hypertensives.

Carotid Artery Scanning

Stroke affects almost 150,000 people in the UK every year and is the third most common cause of death. Anybody can suffer a stroke, even young, ‘healthy’ individuals, although the majority of strokes do occur in people over the age of 65. Stroke is the major cause of disability in the UK with over 250,000 people affected.

1. What is Carotid Disease?

The carotid artery in the neck provides the principal blood supply to the brain. The artery (common carotid artery) runs up the side of the neck and divides into two branches just below the angle of the jaw. One branch supplies the face (external carotid artery). The other branch passes directly to the brain with no other branches in the neck (internal carotid artery).

Arteries tend to narrow where they divide. Narrowing at the carotid bifurcation (division of common carotid artery) may directly restrict the blood supply to the brain. Additionally and more importantly, debris stuck to the narrow area may break off and fly into the brain or into the artery to the eye.

2. How is carotid disease detected clinically?

Debris flying into the brain may produce a mini-stroke. A mini-stroke (transient ischaemic attack or TIA) is a small stroke which usually lasts less than an hour. It affects one side of the body only.
Sometimes there is transient blindness (Amaurosis Fugax) affecting one eye usually lasting only a few seconds. Sometimes the speech centre in the brain is affected leading to either jumbled speech or complete loss of speech. A key feature of a TIA is that it recovers completely.

The right side of the brain supplies the left side of the body and vice versa. Symptoms of weakness are therefore found on the ‘wrong’ side in relation to the arterial narrowing. Transient blindness by contrast affects the same side, because debris passes directly into the back of the same eye.
When TIA symptoms are associated with a very tight narrowing of the artery to the brain there is a high risk of major stroke. The risk of stroke is greatest during the 3-4 months after the TIA.
When the narrowing is less severe, or when there are no symptoms, the risk of stroke is much lower.

There are several illnesses that may seem very much like TIA's. These include migraine, epileptic fits or seizures, a low blood sugar, faint, and changes in heart rhythm. TIA's do not usually cause blackouts, fainting or loss of consciousness. These other illnesses need different treatments and it is important that people with TIA symptoms are seen by a specialist to find out the cause of the trouble.

3. What tests can be used to detect carotid disease?

Sometimes narrowing can be detected with a stethoscope if there is turbulence of blood flow in the artery and a squeaking or rushing noise.

Ultrasound is the main way of diagnosing carotid disease. The ultrasound image may show narrowing on screen where the carotid bifurcation is usually easily been seen. Ultrasound can also be used to study the speed of blood flow at the point of narrowing. Red cells have to speed up to get through the narrowed segment, and the increase in flow velocity is determined by the degree of narrowing. This type of investigation is offered referred to as a Carotid Duplex scan. It is an extremely reliable, safe and cost effective alternative to other procedures such as angiography, CT or MR.