Carotid artery stenosis

Carotid stenosis is a narrowing of the lumen of the carotid artery, usually caused by atherosclerosis. The unqualified term "carotid stenosis" in common medical usage refers to the stenosis in the proximal part of the internal carotid artery (at the carotid bulb), as this is the by far the most common site of stenosis within the carotid arteries. Stenosis in other parts of the carotid arteries does occur.

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Atherosclerotic carotid stenosis may be asymptomatic or it may cause symptoms by embolism to either cerebral vessels in the brain or to the retinal arteries. Emboli to the cerebral arteries cause transient ischaemic attack (TIA) or cerebrovascular accident (CVA). Emboli to the retina produce amaurois fugax or retinal infarction. It is important to note that there are other causes of TIAs, CVAs and retinal ischaemia apart from carotid stenosis.

Diagnosis

Carotid stenosis is usually diagnosed by color flow duplex ultrasound scan of the neck arteries. This involves no radiation, no needles and no contrast agents that may cause allergic reactions. Typically duplex ultrasound scan is the only investigation required for decision making (including proceeding to intervention) in carotid stenosis.

Occasionally further imaging is required. One of several different imaging modalities, such as angiogram, computed tomography angiogram (CTA) or magnetic resonance imaging angiogram (MRA) may be useful. Each imaging modality has its advantages and disadvantages - the investigation chosen will depend on the clinical question and the imaging expertise, experience and equipment available.

Treatment

Options for treatment include:

• Medical management alone (an antiplatelet drug (or drugs) and control of risk factors for atherosclerosis)
• Medical management plus Carotid endarterectomy (surgical removal of the atheroma)
• Medical management plus Carotid stenting

The goal of treatment is to reduce the risk of stroke (cerebrovascular accident). Intervention (carotid endarterectomy or carotid stenting) can cause stroke, however where the risk of stroke from medical management alone is high, intervention may be beneficial.

Clinically, risk of stroke from carotid stenois is evaluated by the presence or absence of symptoms and the degree of stenosis on imaging.

See also

• Ocular ischemic syndrome