Carotid Artery Disease – Dr. Omar Choudhri

What Is Carotid Artery Disease?

Carotid artery disease (also called carotid stenosis) is a condition in which the carotid arteries—the major arteries in the neck that supply blood to the brain—become narrowed by atherosclerotic plaque buildup. This narrowing can restrict blood flow to the brain and, more dangerously, can serve as a source of emboli (fragments of plaque or clot) that travel to the brain and cause a stroke or transient ischemic attack (TIA).
Carotid artery disease is one of the leading treatable causes of stroke, accounting for approximately 10–20% of all ischemic strokes. Early detection and appropriate treatment can dramatically reduce stroke risk.

Symptoms

Many patients have no symptoms — disease is often detected on screening ultrasound or imaging for other purposes
Transient ischemic attack (TIA) — temporary episodes of weakness, numbness, speech difficulty, or vision loss lasting minutes to hours
Stroke — permanent neurological deficits from brain damage
Amaurosis fugax — temporary vision loss in one eye (“shade coming down”)

Diagnosis

Carotid Ultrasound (Duplex): Non-invasive first-line screening test that measures the degree of stenosis and plaque characteristics.
CT Angiography (CTA): Provides detailed cross-sectional imaging of the carotid arteries and intracranial vessels.
Catheter Angiography: Gold standard for precise measurement of stenosis severity and planning intervention.
MRI / Vessel Wall Imaging: Advanced MRI techniques can characterize plaque composition (identifying vulnerable, inflammation-rich plaques at higher risk of causing stroke).

Treatment Options

Carotid Endarterectomy (CEA)

The traditional surgical approach in which the carotid artery is opened and the atherosclerotic plaque is physically removed. CEA has decades of evidence supporting its effectiveness for stroke prevention in patients with significant carotid stenosis. It remains the standard of care for many patients with symptomatic carotid disease.

Transfemoral Carotid Artery Stenting (CAS)

A catheter-based approach in which a stent is placed inside the narrowed carotid artery to hold it open. An embolic protection device is used to capture any debris released during the procedure. CAS is a minimally invasive alternative to CEA, particularly for patients with anatomical features that increase surgical risk (e.g., prior neck surgery, radiation, or very high carotid bifurcation).

Transcarotid Arterial Revascularization (TCAR)

TCAR represents a next-generation hybrid approach that combines the benefits of surgery and stenting. Through a small incision in the neck, direct access to the carotid artery is obtained, and a system temporarily reverses blood flow away from the brain during stent placement. This flow reversal provides superior embolic protection compared to traditional transfemoral stenting

Carotid Revascularization Technologies

ENROUTE TCAR System (Boston Scientific): Dr. Choudhri is a certified TCAR proctor and faculty for the Boston Scientific TCAR Summit, training physicians nationwide in this technique.

Walrus Balloon Guide Catheter: Dr. Choudhri’s multicenter research on the Walrus BGC for carotid revascularization has been published and presented at national meetings.

Acute Stroke Thrombectomy

When carotid disease leads to an acute large vessel occlusion stroke, emergency mechanical thrombectomy—catheter-based removal of the blood clot—can be life-saving. Dr. Choudhri was a collaborator on the landmark SELECT2 trial published in the New England Journal of Medicine, which expanded the criteria for patients eligible for thrombectomy in large ischemic strokes.