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Carotid Artery Disease Diagnosis Overview

Carotid artery disease is a form of peripheral artery disease that affects blood flow through the carotid arteries, the two large vessels (one on each side of your neck) that supply blood to the brain. When you feel your pulse on your neck under your jaw, you are feeling the movement of the carotid artery as blood flows through it.

Disease in the carotid arteries puts you at risk for stroke. Unfortunately, carotid artery disease often goes unnoticed until it has already caused a stroke or TIA (" mini-stroke"). Be sure you know how to recognize the signs of stroke and call 9-1-1 immediately if you notice them, even if they go away quickly:

  • Sudden numbness or weakness of face, arm, or leg, especially on only one side of the body
  • Sudden confusion or trouble speaking or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, or loss of balance or coordination
  • Sudden severe headache with no known cause

Women who are at high risk for stroke because of stroke risk factors (such as high blood pressure, diabetes, or cigarette smoking) may be evaluated for carotid artery disease so that treatment can be started in time to prevent a stroke.

Visit our Stroke Risk Calculator to get an estimate of your stroke risk, and then talk to your doctor to see if you should be evaluated for carotid artery disease.

An examination for carotid artery disease consists of two main parts:

Medical History & Physical Examination

A medical history includes a complete review of any medical conditions you have (especially stroke risk factors), surgeries and other procedures you’ve had in the past, and any medications you are taking (including prescription drugs, over-the-counter medications, and dietary supplements). Your medical history can help your doctor determine your overall risk for stroke and decide if you need additional tests or should be monitored more closely.

You will also have blood tests to evaluate your general health and determine if you have other conditions that make you more likely to develop carotid artery disease.

During the physical examination, your doctor will listen to the blood flow through the carotid artery in your neck using a stethoscope. If the carotid artery is narrowed by atherosclerosis, the gradual buildup of fatty plaque on the walls of the arteries, it may create a characteristic "whooshing" sound called a bruit (BROO-ee). Not all women with carotid artery disease have a bruit, and not all bruits are caused by artery disease.1

If the doctor hears a carotid bruit, or if you are at high risk for stroke because of other conditions, she or he will order an imaging test to look at the carotid arteries. See Evaluating Your Risk for Stroke to learn more about how to determine your stroke risk.

Imaging Tests

The main imaging test used to diagnose carotid artery disease is a carotid duplex ultrasound. This fast, inexpensive test uses reflected sound waves—like those used to see the fetus during pregnancy—to create detailed images of the inside of the carotid arteries. Carotid duplex ultrasound can detect blood flow problems caused by fatty deposits on the walls of the arteries.

If the ultrasound does not provide enough information, your doctor may order additional imaging tests. These tests can help determine if you would benefit from a procedure to clear the carotid arteries to help prevent a stroke.

  • MR angiogram – a special form of magnetic resonance imaging (MRI) that uses radio waves and a large magnet to produce images of blood flow in the carotid artery and brain.
  • CT angiogram – uses X-rays and a computer to produce images of your carotid arteries. A special dye (injected into a vein in your arm) is used to highlight the arteries.
  • Contrast Angiogram of the Head and Neck – the gold standard test for carotid artery disease. To perform the test, a long, thin tube called a catheter is inserted into an artery in your groin or arm and guided to the carotid artery. The catheter injects a dye into the blood vessels of your head and neck, and the dye is filmed by an X-ray camera, producing a movie of your carotid arteries as the blood moves through them. Although this procedure is very safe, there are some risks because it involves entering the body.

Carotid Artery Disease Diagnosis Overview

Carotid Artery Disease Diagnosis Flow Chart

What happens next?

If you have carotid artery disease that has not caused any symptoms (such as a stroke or TIA), your treatment will focus on lifestyle changes and medication to slow the progression of the disease and reduce your risk for stroke. See Preventing Stroke: the Basics for three simple steps you can take to reduce your stroke risk.

Women with severe blockages in their carotid arteries, or with moderate blockages who have already suffered a stroke or TIA, may need a procedure to open the arteries and prevent a stroke, such as carotid endarterectomy or carotid stenting. You will also need to make healthy lifestyle changes and take medications (such as statin drugs and aspirin) to reduce your stroke risk.


  1. Ratchford EV, Jin Z, Di Tullio MR, et al. Carotid bruit for detection of hemodynamically significant carotid stenosis: the Northern Manhattan Study. Neurol Res. Sep 2009;31(7):748-752.

Filed in Tests & Diagnosis > Peripheral Vascular Disease