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The build-up of plaque in the internal carotid artery may occasionally lead to narrowing and irregularity of the artery's channel, preventing proper blood flow to the brain. Sometimes, pieces of plaque in the internal carotid artery can break free, travel to the brain, and block blood vessels that supply blood to the brain. The most common complication of severe narrowing is the formation of clots on the fatty plaques. If the clots break free and travel to the brain, they can cause a stroke, with possible paralysis or other deficits.