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Health condition

Carotid artery disease, from silent narrowing to sudden stroke, and everything in between.

A hub guide to the arteries that feed your brain, covering stenosis, dissection, FMD, aneurysm and vasculitis, with the imaging and treatment options that actually change outcomes.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE, ESVS and peer-reviewed vascular sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice on stroke prevention, carotid imaging, endarterectomy and stenting.

Key facts

Carotid artery disease at a glance.

The essentials, in plain English. What the carotid arteries do, the main patterns of disease and how UK teams treat them.

  • What it is

    A group of conditions affecting the carotid arteries in the neck, from plaque narrowing to dissection, dysplasia and rare tumours.

  • Main types

    Atherosclerotic stenosis, dissection, fibromuscular dysplasia (FMD), aneurysm, vasculitis, post-radiation disease and carotid body tumours.

  • Why it matters

    The carotid arteries feed the brain. Disease in them is a major and treatable cause of stroke and TIA.

  • Who gets it

    Atherosclerosis in older adults with vascular risk factors; dissection and FMD often in younger adults, especially women.

  • First-line imaging

    Carotid duplex ultrasound, with CT or MR angiography when detail or intracranial views are needed.

  • Foundations of care

    Risk-factor control, antiplatelet or anticoagulant therapy, statin, blood pressure control and, when needed, endarterectomy or stenting.

Why this guide matters

One neck, several very different diseases.

Carotid disease covers everything from age-related plaque to spontaneous dissection in young adults. Treatment depends entirely on getting the diagnosis right.

  • Atherosclerosis is a stroke story

    Carotid stenosis is one of the biggest treatable causes of stroke. Timely surgery or stenting saves brain tissue.

  • Dissection is a young-adult story

    A tear in the arterial wall can happen after minor trauma or spontaneously, often presenting with pain and Horner syndrome.

  • Rare causes still matter

    FMD, vasculitis, radiation change and carotid body tumours are uncommon but each has its own pathway and outlook.

Types

The main patterns of carotid disease.

A quick tour of the seven patterns you are most likely to hear about, and where each fits in the wider picture.

How the diagnosis is made

From symptoms to a treatment plan.

The steps a UK GP, stroke team or vascular surgeon will typically follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and stroke risk

    Vascular history, TIA symptoms, neck trauma, headache and family history of dissection or FMD.

  2. 02

    Assessing

    Examination

    Blood pressure in both arms, pulses, cardiac auscultation, a carotid bruit and a focused neurological check.

  3. 03

    Assessing

    Blood tests

    Lipids, HbA1c, kidney function, inflammatory markers and, in selected patients, a vasculitis screen.

  4. 04

    Imaging

    Carotid duplex ultrasound

    The first-line scan for stenosis, plaque and flow; also picks up many dissections and aneurysms.

  5. 05

    Imaging

    CT or MR angiography

    Cross-sectional imaging of the neck and brain vessels to confirm dissection, FMD, aneurysm or intracranial disease.

  6. 06

    Imaging

    Digital subtraction angiography

    Reserved for complex cases, planning of stenting or when non-invasive imaging is inconclusive.

  7. 07

    Planning

    Vascular MDT and plan

    A vascular MDT weighs medical therapy, endarterectomy and stenting and agrees a timeline with you.

Typical timeline: from a TIA to a settled treatment plan within two weeks in most UK pathways.

Symptoms

What carotid disease actually feels like.

Many people have no symptoms until something dramatic happens. Others get subtle warnings that are worth taking seriously.

  • Asymptomatic carotid bruit

    A whooshing sound over the neck picked up on examination, sometimes the first clue to underlying stenosis.

  • Amaurosis fugax

    A curtain-like temporary loss of vision in one eye, caused by a small embolus to the retinal artery.

  • Transient ischaemic attack

    A brief episode of weakness, numbness or speech disturbance that fully resolves, but signals high stroke risk.

  • Stroke

    Sudden face, arm or speech symptoms lasting beyond 24 hours, often from an embolus off a carotid plaque or dissection.

  • Horner syndrome (dissection)

    Drooping eyelid, small pupil and reduced facial sweating on one side, classic for a carotid dissection.

  • Neck or head pain

    Sudden unilateral neck pain or headache, sometimes after trivial trauma, is a warning sign for dissection.

  • Pulsatile neck mass

    A visible or palpable pulsatile swelling can point to a carotid aneurysm or a carotid body tumour.

  • Red flag - new focal neurology

    Any sudden speech, vision, weakness or balance symptom needs emergency assessment via 999 or the local stroke pathway.

Treatment

How carotid disease is treated in the UK.

Best medical therapy for everyone, with endarterectomy, stenting or disease-specific therapy on top when the anatomy or diagnosis calls for it.

  • Vascular risk factor modification

    Smoking cessation, weight, diet, exercise and diabetes control shape long-term stroke and cardiovascular risk more than any single drug.

  • Antiplatelet therapy

    Aspirin or clopidogrel, often lifelong, to reduce stroke risk in atherosclerotic carotid disease and after TIA.

  • Statin therapy

    High-intensity statins stabilise plaque and cut future stroke and cardiovascular events, regardless of baseline cholesterol.

  • Blood pressure control

    ACE inhibitors, ARBs and other agents to a target agreed with your clinician, tightly controlled but avoiding sudden drops.

  • Anticoagulation for dissection

    Antiplatelet or anticoagulant therapy for weeks to months, guided by imaging and specialist review.

  • Carotid endarterectomy (CEA)

    Open surgical removal of plaque, offered for symptomatic significant stenosis, ideally within two weeks of the event.

  • Carotid artery stenting (CAS)

    A catheter-based option for selected patients, especially with hostile necks, prior surgery or specific anatomy.

  • Disease-specific therapy

    Immunosuppression for vasculitis, endovascular repair for aneurysm and surgical excision for carotid body tumours.

For the procedural detail on endarterectomy and stenting, see our companion guide to carotid artery stenting.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and international vascular society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, stroke physician or vascular surgeon knows your case and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128).

  • ESVS. Clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease.

  • European Stroke Organisation. Guidelines on cervical artery dissection.

  • Royal College of Physicians. National clinical guideline for stroke for the UK and Ireland.

Red flags

When carotid symptoms need urgent attention.

Some presentations cannot wait for a routine outpatient appointment. If any of these apply, seek urgent help today.

  • FAST symptoms

    Facial droop, arm weakness or speech disturbance means call 999 immediately - time is brain.

  • Repeated TIAs

    More than one transient episode in a short window signals a very high early stroke risk and needs same-day assessment.

  • Sudden severe neck or head pain

    Especially after minor trauma, chiropractic manipulation or straining, with any neurology, suggests carotid dissection.

  • New Horner syndrome

    Ptosis, miosis and reduced facial sweating on one side is a red flag for dissection until proven otherwise.

  • Rapidly enlarging neck mass

    A growing pulsatile mass may be an aneurysm and needs urgent vascular review.

  • Fever with vascular symptoms

    New fever, weight loss and vascular symptoms can suggest vasculitis or, rarely, a mycotic aneurysm.

  • Post-radiation neck symptoms

    Previous neck radiotherapy raises the risk of accelerated carotid disease, worth flagging to any clinician.

  • Young stroke or TIA

    A stroke or TIA under 55 without obvious cause deserves imaging for dissection, FMD and cardiac sources.

  • Pregnancy or postpartum symptoms

    Pregnancy and the postpartum period carry a higher risk of dissection - vascular symptoms should be taken seriously.

Living with it

A long-term condition, with a clear plan.

Four things make the biggest difference between one event and a lifetime of stability, whichever pattern of carotid disease you have.

A quiet reminder

Consistency beats intensity, every time.

Blood pressure logged, medication taken and reviews attended year after year outperform any short burst of motivation.

  1. 01 Foundations

    Get the basics right

    Blood pressure, cholesterol, blood sugar, weight and smoking cessation together outperform any single procedure.

  2. 02 Vigilance

    Know your stroke symptoms

    Learn FAST and share it with family. Speed of response is one of the strongest predictors of recovery.

  3. 03 Adherence

    Stay on your medication

    Antiplatelets and statins only work if taken. Set reminders, use weekly pill organisers and review annually.

  4. 04 Follow-up

    Keep your surveillance dates

    Regular duplex scans or specialist reviews spot progression early, while treatment remains straightforward.

Frequently asked

Everything we get asked about carotid disease.

Quick answers on stenosis, dissection, FMD, surgery, stenting and long-term stroke prevention.

  • What is carotid artery disease?

    It is an umbrella term for conditions that narrow, weaken or damage the carotid arteries in the neck. It includes atherosclerosis and carotid stenosis, dissection, fibromuscular dysplasia, aneurysm, vasculitis, post-radiation change and, less commonly, carotid body tumours.

  • How is carotid stenosis different from carotid dissection?

    Carotid stenosis is a narrowing from plaque build-up, usually in older adults with vascular risk factors. Carotid dissection is a tear in the artery wall, often in younger adults after minor trauma or spontaneously, and needs anticoagulation or antiplatelet therapy rather than surgery in most cases.

  • What is fibromuscular dysplasia?

    FMD is a non-inflammatory, non-atherosclerotic condition that produces a characteristic string-of-beads appearance in medium-sized arteries. It is more common in women and can cause dissection, aneurysm or TIA. Most patients are managed with antiplatelet therapy and monitoring.

  • Do I need surgery for carotid stenosis?

    Not always. Symptomatic significant stenosis (usually 50 to 99 per cent) is offered carotid endarterectomy or stenting alongside medical therapy. Asymptomatic stenosis is usually managed with medication and surveillance unless very tight or high risk.

  • What is the difference between endarterectomy and stenting?

    Carotid endarterectomy removes plaque through an incision in the neck. Carotid artery stenting places a mesh tube from inside the artery via a catheter. Both prevent stroke; the best choice depends on anatomy, age, previous surgery or radiation, and patient preference.

  • Can lifestyle changes actually shift my risk?

    Yes. Stopping smoking, controlling blood pressure, taking a statin and staying active are among the most powerful stroke-prevention tools we have, often halving future events on top of any procedure.

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