The carotids are the main arteries that supply blood to the brain. They are located in the cervix, where they each rise to the corresponding hemisphere of the brain, thus providing its oxygenation.

Carotid disease is due to the formation of atherosclerotic plaque, which causes a narrowing of the carotid bifurcation (the common carotid divides into the internal carotid artery, which supplies blood to the brain, and the external carotid artery, which supplies blood to the neck and face).

Carotid stenosis is dangerous, as it can lead to an ischemic stroke for two main reasons:

• Due to atheroembolism: Small pieces of plaque break off and are carried by the blood stream to the brain, causing blockages in smaller arteries.
• Due to sudden occlusion of the internal carotid artery: Thrombosis in the internal carotid artery can drastically reduce blood flow to the brain and cause an ischemic stroke.

Ischemic strokes are the third leading cause of death and the leading cause of disability in Europe. Many risk factors have been identified as contributing to the appearance and progression of carotid disease: increased age, smoking, diabetes mellitus, arterial hypertension, hypercholesterolemia. The coexistence of several risk factors significantly increases the likelihood of severe carotid disease.

When carotid stenosis is not significant, it usually causes no symptoms. This is an asymptomatic stenosis. It is a symptomatic narrowing when it leads to an ischemic stroke. Neurological symptoms depend on the part of the brain affected: hemiparesis, hemiplegia, loss of expression (aphasia/dysarthria) or loss of vision in one eye.

Screening with triplex (specialized ultrasound) is recommended for the diagnosis of possible carotid stenosis in all patients presenting with neurological symptoms corresponding to areas of the brain supplied by the internal carotid artery, as well as in asymptomatic patients with suspected carotid stenosis due to the presence of factors cardiovascular risk.

Medical treatment is necessary for all patients with carotid stenosis and combines taking antiplatelet drugs, statin and improving the risk factors of atherosclerotic disease (smoking cessation, sugar regulation, etc.). The need for surgery or endovascular intervention (stent placement) depends on the degree of stenosis, the morphology of the atherosclerotic plaque and the symptoms. In general, surgery is recommended for carotid stenosis greater than 70% in order to prevent future ischemic stroke.