Overview
Summary
Carotid disease is disease of the cervical carotid arteries that causes ischaemic stroke, transient ischaemic attack (TIA) and retinal ischaemia. Atherosclerotic plaque at the carotid bifurcation is the commonest cause. Dissection, fibromuscular dysplasia and arteritis are rarer causes. Stenosis is graded as the percentage narrowing of the lumen by the method of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and it is imaged with duplex ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Management combines medical therapy for every patient with carotid endarterectomy (CEA) or carotid artery stenting (CAS) for selected patients. A stenosis that has caused an ipsilateral TIA, stroke or retinal event is symptomatic, and its page covers early risk, timing and the choice of procedure.
Takeaways
- 1
Report stenosis by the NASCET method and name the method, because ECST values run considerably higher.
- 2
Set a low LDL-cholesterol target after ischaemic stroke or TIA with atherosclerosis, whatever the revascularisation decision.
- 3
Refer patients for carotid procedures to high-volume operators and centres, which were associated with less procedural death or stroke.
Start here
- Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling studySong 2020 · Lancet Glob Health
- Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative GroupRothwell 1994 · Stroke · landmark
- Management of atherosclerotic extracranial carotid artery stenosisBonati 2022 · Lancet Neurol
- A Comparison of Two LDL Cholesterol Targets after Ischemic StrokeAmarenco 2020 · N Engl J Med · pivotal
Summary
Carotid disease is disease of the cervical carotid arteries that causes ischaemic stroke, transient ischaemic attack (TIA) and retinal ischaemia. Atherosclerotic plaque at the carotid bifurcation is the commonest cause. Dissection, fibromuscular dysplasia and arteritis are rarer causes. Stenosis is graded as the percentage narrowing of the lumen by the method of the North American Symptomatic Carotid Endarterectomy Trial (NASCET), and it is imaged with duplex ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA). Management combines medical therapy for every patient with carotid endarterectomy (CEA) or carotid artery stenting (CAS) for selected patients. A stenosis that has caused an ipsilateral TIA, stroke or retinal event is symptomatic, and its page covers early risk, timing and the choice of procedure.
Takeaways
- 1
Report stenosis by the NASCET method and name the method, because ECST values run considerably higher.
- 2
Set a low LDL-cholesterol target after ischaemic stroke or TIA with atherosclerosis, whatever the revascularisation decision.
- 3
Refer patients for carotid procedures to high-volume operators and centres, which were associated with less procedural death or stroke.
Start here
- Global and regional prevalence, burden, and risk factors for carotid atherosclerosis: a systematic review, meta-analysis, and modelling studySong 2020 · Lancet Glob Health
- Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative GroupRothwell 1994 · Stroke · landmark
- Management of atherosclerotic extracranial carotid artery stenosisBonati 2022 · Lancet Neurol
- A Comparison of Two LDL Cholesterol Targets after Ischemic StrokeAmarenco 2020 · N Engl J Med · pivotal