Dr Michael Valente

Carotid Artery Stenosis

Assessment and management of narrowing in the carotid arteries — a major and treatable cause of stroke.

The carotid arteries in the neck supply most of the blood flow to the brain. When atherosclerotic plaque builds up inside them, the resulting narrowing — carotid stenosis — can cause stroke or TIA either by reducing blood flow or by acting as a source of small clots travelling to the brain.

Carotid disease may be discovered after a stroke or TIA (symptomatic stenosis) or detected incidentally on imaging in someone without symptoms (asymptomatic stenosis). Each requires a different approach, and timing of intervention can substantially affect long-term outcomes.

How Carotid Stenosis Presents

Carotid stenosis is often silent until it causes a vascular event. When symptoms occur, they may include:

• Sudden weakness or numbness on one side of the body
• Slurred speech or difficulty understanding speech
• Sudden, painless loss of vision in one eye (amaurosis fugax)
• TIA or stroke on the side of the body opposite the affected artery

In many cases the condition is first identified through a neck bruit on examination or as an incidental finding on imaging done for another reason.

Investigations

Accurate measurement of the degree of stenosis and characterisation of plaque guides treatment. Investigations may include:

• Carotid duplex ultrasound
• CT angiography of the head and neck
• MR angiography
• Brain MRI to assess for prior silent infarction
• Cardiovascular risk assessment, including lipids, glucose, and blood pressure review

Treatment Options

Management is individualised, balancing the degree of stenosis, whether it has caused symptoms, overall vascular risk, and patient preferences. Options typically considered include:

• Best medical therapy — antiplatelet medication, intensive cholesterol lowering (usually a high-intensity statin), blood pressure control, diabetes management, and lifestyle modification
• Carotid endarterectomy — surgical removal of plaque from the artery, typically considered for symptomatic moderate-to-severe stenosis
• Carotid artery stenting — an endovascular alternative for selected patients
• Surveillance imaging — for asymptomatic or moderate disease where intervention is not yet warranted

Where intervention is appropriate, Dr Valente coordinates closely with vascular surgery and interventional neuroradiology colleagues, and provides ongoing neurological follow-up.

Trusted Resources

Reputable Australian organisations providing information about carotid disease and stroke prevention.

• Stroke Foundation Australia — the national peak body for stroke awareness, prevention, and survivor support.
• Heart Foundation Australia — cardiovascular risk factor information including blood pressure and cholesterol.
• Better Health Channel — Heart Disease and Stroke — Victorian Government overview of cardiovascular disease.
• Brain Foundation — Australian research and information across neurological conditions.

StrokeLine (free advice from allied health professionals): 1800 787 653, Mon–Fri 9am–5pm AEST.

Referrals & Bookings

A current GP or specialist referral is required for Medicare rebates. Where possible, please forward any prior carotid imaging or vascular reports with the referral.

To arrange an appointment, visit the Bookings page or get in touch via Contact.

This is general information only and not a substitute for individual medical advice.
All referrals will be reviewed when received and triaged appropriately.