How is carotid artery disease diagnosed?

There may not be any symptoms of carotid artery disease. If you are at risk, it is important to have regular physical exams.

A doctor will listen to the arteries in your neck with a stethoscope. An abnormal rushing sound, called a bruit (pronounced BROO-ee), may indicate carotid artery disease. However, bruits are not always present when there are blockages, and may be heard even when the blockage is minor.

Diagnostic tests include:

  • Carotid duplex ultrasound: An imaging procedure that uses high-frequency sound waves to view the carotid arteries to determine if there is narrowing. This is the most common test utilized to evaluate for the presence of carotid artery disease.
  • Carotid angiography (carotid angiogram, carotid arteriogram, carotid angio): During this invasive imaging procedure, a catheter (thin, flexible tube) is inserted into a blood vessel in the arm or leg, and guided to the carotid arteries with the aid of a special X-ray machine. Contrast dye is injected through the catheter while X-rays of the carotid arteries are taken. This test may be performed to evaluate or confirm the presence of narrowing or blockage in the carotid arteries, determine the risk for future stroke and evaluate the need for future treatment, such as carotid stenting or surgery.
  • Magnetic resonance angiogram (MRA): MRA is a type of magnetic resonance image (MRI) scan that uses a magnetic field and radio waves to provide pictures of the carotid arteries. In many cases, MRA can provide information that cannot be obtained from an X-ray, ultrasound, or computed tomography (CT) scan. This test can provide important information about the carotid and vertebral arteries and the degree of stenosis.
  • Computerized tomography (CT Scan): A CT of the brain may be performed if a stroke or TIA is suspected to have already occurred. During a CT scan, X-rays pass through the body and are picked up by detectors in the scanner, which produce three-dimensional (3D) images on a computer screen. Depending on the type of scan you need, a contrast material might be injected intravenously (into a vein) so the radiologist can see the body structures on the CT image. This test may reveal areas of damage in the brain.
  • Computed tomography angiogram (CTA): A test that uses advanced CT technology, along with intravenous (IV) contrast material (dye), to obtain high-resolution, 3D pictures of the carotid arteries. CTA images enable physicians to determine the degree of stenosis in the carotid and vertebral arteries and can also assess leading to these arteries as well as the blood vessels in the brain.

Reviewed by a Cleveland Clinic medical professional.

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