Carotid and vertebral artery stenosis are conditions that affect the major blood vessels supplying the brain. While often discussed in the context of stroke prevention, these vascular issues frequently intersect with the work I do as a brain and spine surgeon — particularly when patients present with neurological symptoms that require careful evaluation.

What Is Carotid and Vertebral Artery Stenosis?

Carotid artery stenosis refers to narrowing of the carotid arteries — the two large arteries in the front of the neck that deliver oxygen-rich blood to the brain.

Vertebral artery stenosis involves narrowing of the vertebral arteries, which run along the spine and join to form the basilar artery at the base of the brain.

In both cases, the narrowing is most commonly caused by atherosclerosis — plaque buildup along the arterial walls. As the passageway narrows, blood flow to the brain may become compromised.

Symptoms I Often See

Many patients are referred after experiencing:

• Transient ischemic attacks (TIAs), sometimes called “mini-strokes”

• Dizziness or imbalance

• Visual disturbances

• Weakness or numbness on one side of the body

• Speech difficulty

• Posterior circulation symptoms (more common with vertebral artery disease), such as coordination problems

In some cases, stenosis is discovered incidentally during imaging performed for another reason — such as evaluation of neck pain, spine conditions, or after a trauma workup.

Diagnosis

Diagnosis typically begins with noninvasive imaging, including:

• Carotid ultrasound

• CT angiography (CTA)

• MR angiography (MRA)

When needed, more detailed vascular imaging may be obtained to better understand the degree of narrowing and blood flow dynamics.

Common Treatment Approaches

Treatment depends on the severity of narrowing, the presence of symptoms, and overall patient health. In many cases, management is multidisciplinary, involving primary care physicians, neurologists, vascular surgeons, cardiologists, and neurosurgeons.

Common treatment strategies include:

1. Medical Management

For mild to moderate stenosis:

• Antiplatelet therapy

• Cholesterol management

• Blood pressure control

• Smoking cessation

• Lifestyle modifications

2. Carotid Endarterectomy (CEA)

A surgical procedure that removes plaque from the carotid artery. This is often considered in patients with significant narrowing who have experienced symptoms.

3. Carotid Artery Stenting (CAS)

A minimally invasive option where a stent is placed to widen the artery and improve blood flow.

4. Vertebral Artery Intervention

Vertebral artery stenosis is often treated medically, though select cases may require endovascular stenting or surgical bypass depending on anatomy and symptom profile.

Why This Matters in Brain and Spine Surgery

As a neurosurgeon, my role often involves:

• Evaluating stroke risk in patients undergoing spinal or cranial surgery

• Coordinating care when vascular findings are discovered during imaging

• Managing complex cases where vascular and structural spine issues overlap

• Ensuring safe surgical planning in patients with known vascular disease

Understanding the vascular supply to the brain and spinal cord is critical in surgical decision-making. Even when stenosis is not the primary diagnosis, it may influence timing, approach, or perioperative management.

A Collaborative Approach

Carotid and vertebral artery stenosis are serious but treatable conditions. Early detection, appropriate imaging, and coordinated care are key to reducing risk and improving outcomes.

If patients are experiencing neurological symptoms — even briefly — prompt evaluation is important. In my practice, collaboration with trusted colleagues across specialties ensures that each patient receives individualized, comprehensive care.

This article is intended for educational purposes only and does not constitute medical advice. If you have concerns about neurological symptoms or vascular health, please consult your healthcare provider.