Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
- cervical bruit
- focal neurological deficit lasting >24 hours (i.e., stroke)
- focal neurological deficit lasting <24 hours (i.e., transient ischaemic attack [TIA])
Risk factors
- older age
- history of hypertension
- smoking
- history of cardiovascular disease
- history of hypercholesterolaemia
Diagnostic investigations
1st investigations to order
- duplex ultrasonography
- computed tomography angiography (CTA) of head, neck, and chest
Investigations to consider
- magnetic resonance angiography (MRA) of head, neck, and chest
- cervical angiography
- CT brain
- MRI brain
Treatment algorithm
Contributors
Authors
Professor of Stroke Medicine
UCL Stroke Research Centre
Department of Brain Repair and Rehabilitation
UCL Queen Square Institute of Neurology
University College London
London
Disclosures
MMB received a project grant from the Stroke Association to support the European Carotid Surgery Trial-2; he is also an author of references cited in this topic.
Professor Martin M. Brown would like to gratefully acknowledge Dr Brajesh K. Lal, the previous contributor to this topic.
Disclosures
BKL is an author of references cited in this topic.
Peer reviewers
Stewart J. Greenebaum Endowed Professor of Stroke Neurology
Director, Comprehensive Stroke Program
Vice-Chair for Strategic Operations
Department of Neurology
University of Maryland School of Medicine
Baltimore
MD
Disclosures
SC declares that he is an executive committee member of the CREST-2 study.
Professor and Chief
Vascular and Endovascular Surgery
NYU Langone Medical Center
New York
NY
Disclosures
MAA declares that he has no competing interests.
Assistant Professor of Surgery and Radiology
Yale University School of Medicine
New Haven
CT
Disclosures
JEI declares that he has no competing interests.
Professor of Surgical Education
Consultant Vascular Surgeon
Sheffield Vascular Institute
Sheffield
UK
Disclosures
JDB declares that he is on the Steering Committee of ICSS and ECST-2 Trials.
Professor of Vascular Surgery
Vascular Surgery Group
Division of Cardiovascular Sciences
Leicester Royal Infirmary
UK
Disclosures
RN declares that he has no competing interests.
Professor of Vascular Surgery
Head, Department of Vascular Surgery
Athens Medical Center
Athens
Greece
Disclosures
CDL declares that he has no competing interests.
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