Carotid Artery Disease: Stroke Prevention and Carotid Endarterectomy Surgery in Singapore

Background

The carotid arteries are the two main blood vessels on either side of the neck that supply blood to the brain. Like other arteries in the body, they can become narrowed or blocked due to atherosclerosis — the build-up of cholesterol, fat, and calcium in the artery wall. This condition is known as carotid artery disease.

Carotid artery disease is important because it can lead to stroke. Stroke is caused either by a blood clot forming in the carotid artery and travelling to the brain, or by complete blockage of blood flow. Preventing stroke is the main goal of treating carotid artery disease.

Symptoms of Carotid Artery Disease

Many patients with carotid disease have no symptoms. However, some may experience “warning signs” called transient ischaemic attacks (TIAs) or “mini-strokes.” Symptoms can include:

• Sudden weakness or numbness in the face, arm or leg (especially on one side of the body)

• Sudden loss of vision in one eye

• Sudden difficulty speaking or understanding speech

• Loss of balance or coordination

TIAs are a serious warning sign — without treatment, there is a high risk of a major stroke in the following days or weeks.

Diagnosis

Carotid artery disease is usually diagnosed with:

• Duplex ultrasound: A painless scan to measure blood flow and narrowing.

• CT angiography or MR angiography: Detailed imaging to guide treatment.

• Catheter angiography: Sometimes used if surgery or stenting is being considered.

Treatment Options

• Best medical therapy: All patients with carotid artery disease should receive lifestyle advice (stop smoking, healthy diet, exercise) and medications such as blood thinners, cholesterol-lowering drugs, and blood pressure control.

• Carotid Endarterectomy (CEA):

  This is the gold standard surgical treatment for significant carotid narrowing in patients with symptoms. The surgeon makes an incision in the neck, opens the carotid artery, removes the plaque, and then repairs the artery. Carotid endarterectomy has been shown in major international trials to reduce the risk of future stroke by up to 50% compared with medical therapy alone.

• Carotid Artery Stenting (CAS):

  In selected cases, particularly in patients at high surgical risk, a stent can be placed via a minimally invasive catheter-based procedure. However, international guidelines generally recommend endarterectomy as the first-line treatment for most patients.

Summary

Carotid artery disease is a leading cause of stroke. In patients with significant narrowing and symptoms such as TIA or minor stroke, carotid endarterectomy offers proven stroke prevention. With modern surgical techniques, anaesthesia and perioperative care, the risks are low, and the benefits in terms of stroke reduction are substantial.

As a vascular and endovascular surgeon in Singapore, I provide comprehensive care for patients with carotid artery disease — from diagnosis and medical optimisation to carotid endarterectomy and long-term stroke prevention.

Frequently Asked Questions (FAQ) about Carotid Artery Disease

What causes carotid artery disease?

It is caused by atherosclerosis — fatty and calcified deposits building up in the artery wall. Risk factors include smoking, diabetes, high blood pressure, high cholesterol, and age.

What is a TIA or “mini-stroke”?

A transient ischaemic attack (TIA) happens when blood flow to the brain is temporarily reduced. Symptoms may last only minutes, but a TIA is a red flag for future stroke risk.

Do all patients with carotid narrowing need surgery?

No. Many patients with mild narrowing can be managed with medication and lifestyle changes. Surgery is usually recommended if narrowing is severe (typically >70%) and the patient has symptoms.

What is carotid endarterectomy?

It is a surgical procedure where the artery is opened and the plaque removed to restore blood flow to the brain. It is the most effective operation to prevent stroke in patients with symptomatic carotid disease.

Is carotid endarterectomy safe?

Yes. In experienced hands, the risk of stroke or death from the operation is usually <3% — much lower than the risk of leaving the narrowing untreated.

What is the recovery after carotid surgery?

Most patients spend 1–2 days in hospital. Recovery is usually quick, with patients resuming normal activity within 1–2 weeks.

Can carotid stenting replace surgery?

Carotid stenting may be an option for patients who are at high risk for surgery or have anatomy unsuitable for endarterectomy. However, in most cases, surgery remains the preferred treatment.