Carotid artery stenosis

Stroke is the fifth leading cause of death, and the leading cause of disability in the UK and US. Carotid artery stenosis causes approximately 10% to 15% of all ischaemic strokes.

Atherosclerotic plaque in the cervical carotid artery is the most common cause. Plaque disruption and atheroembolisation into the intracranial circulation is the most common mechanism for stroke.

The majority of carotid artery stenoses are mild or moderate, and asymptomatic.

Duplex ultrasonography is the preferred mode of diagnosis; CT or magnetic resonance angiography helps to define the anatomy if intervention is indicated.

All patients with carotid artery stenosis should receive antiplatelet therapy, as well as risk factor modification.

Carotid revascularisation of high-grade asymptomatic, and moderate or high-grade symptomatic, carotid artery stenosis prevents future stroke.

Carotid artery stenosis is a narrowing of the lumen of the carotid artery. Atherosclerotic plaque in the cervical carotid artery is the most common cause. The unique haemodynamics at the carotid bifurcation predisposes this area to atherosclerosis. The majority of patients have mild- or moderate-sized plaques, while some develop high-grade stenoses. A small percentage of plaques may rupture and embolise to occlude intracranial arteries (causing a transient ischaemic attack or stroke) or occlude retinal arteries (to cause amaurosis fugax or retinal strokes).