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])
Other diagnostic factors
- transient visual symptoms
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
asymptomatic carotid stenosis <70%
asymptomatic carotid stenosis ≥70%
symptomatic
bilateral carotid stenosis
carotid restenosis
Contributors
Authors
Martin M. Brown, MA, MD, FRCP
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.
Acknowledgements
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
Seemant Chaturvedi, MD, FAAN, FAHA, FANA, FESO
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.
Mark A. Adelman, MD
Professor and Chief
Vascular and Endovascular Surgery
NYU Langone Medical Center
New York
NY
Disclosures
MAA declares that he has no competing interests.
Jeffrey E. Indes, MD, FACS
Assistant Professor of Surgery and Radiology
Yale University School of Medicine
New Haven
CT
Disclosures
JEI declares that he has no competing interests.
Jonathan D. Beard, ChM, Med, FRCS
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.
Ross Naylor, MBBS
Professor of Vascular Surgery
Vascular Surgery Group
Division of Cardiovascular Sciences
Leicester Royal Infirmary
UK
Disclosures
RN declares that he has no competing interests.
Christos D. Liapis, MD, PhD, FACS, FRCS, FEBVS
Professor of Vascular Surgery
Head, Department of Vascular Surgery
Athens Medical Center
Athens
Greece
Disclosures
CDL declares that he has no competing interests.
Differentials
- Carotid dissection or subintimal haematoma
- Thrombotic occlusion of the carotid artery resulting from plaque rupture
- Fibromuscular dysplasia
More DifferentialsGuidelines
- 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases
- Management of atherosclerotic carotid and vertebral artery disease
More GuidelinesPatient leaflets
Carotid artery stenosis: what is it?
Carotid artery stenosis: what treatments work?
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer