How is carotid artery disease diagnosed?
Gabriel P. Lasala, MD
Interventional Cardiology
For diagnosing carotid artery disease, a standard test is to ultrasound the carotid artery. If the ultrasound shows areas of concern, a CT angiography is the next step.
James F. Benenati, MD
Diagnostic Radiology
A good history and physical exam is the beginning and critical step in establishing a diagnosis. If a physician suspects that a patient has a carotid narrowing, he or she will refer the patient for an imaging test.  Diagnosis is usually made by Duplex Ultrasound and may be confirmed with other imaging tests such as CT or MRI.

Stroke neurologist Dr. Carolyn Brockington explains how carotid artery disease is diagnosed. Watch Dr. Brockington's video for important tips and information about the health of your brain.

Physicians have a number of techniques available to them for diagnosing carotid artery disease. Your doctor will first take your medical history, nothing risk factors such as high blood pressure, diabetes, or a family history of carotid artery disease. At this time, your physician will also make note of any previous signs of carotid artery disease, such as strokes or transient ischemic attacks (“mini-strokes”).

Your physician will then give you a physical exam. As part of this exam, your doctor may hold a stethoscope over the carotid arteries on either side of your neck and ask you to hold your breath. If your doctor hears a whooshing sound, called a bruit, you may have narrowing of the carotid arteries. This test predicts narrowing of the arteries better than it does impending stroke, and is used as a starting point for diagnosis, rather than confirmation of a diagnosis.

Discovery of a bruit or other indicators may then prompt your physician to refer you for diagnostic tests such as carotid ultrasound, computed tomography (CT) angiography, magnetic resonance angiography (MRA), or cerebral angiography.

When your doctor suspects that you have a significant degree of stenosis in your carotid arteries, she or he will examine you and conduct tests including:

- Duplex ultrasound cerebral angiogram

- Magnetic resonance angiogram (MRA)

- Computed tomography angiogram (CTA)

Eastside Medical Center
Although symptoms or physical exam may detect carotid stenosis, the best way is found with imaging. Primarily we use carotid ultrasound, but x-ray studies or MRI are frequently used not only to diagnose the condition but to allow better treatment of it using catheter-based intervention.