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Carotid artery stenosis

Last reviewed: 28 Oct 2023
Last updated: 31 Oct 2019



History and exam

Key diagnostic factors

  • asymptomatic
  • cervical bruit
  • focal neurologic deficit lasting >24 hours (i.e., stroke)
  • focal neurologic deficit lasting <24 hours (i.e., transient ischemic attack [TIA])
More key diagnostic factors

Other diagnostic factors

  • transient visual symptoms
Other diagnostic factors

Risk factors

  • older age
  • history of hypertension
  • smoking
  • history of cardiovascular disease
  • history of hypercholesterolemia
More risk factors

Diagnostic investigations

1st investigations to order

  • duplex ultrasonography
  • computed tomography angiography (CTA) of head, neck, and chest
More 1st investigations to order

Investigations to consider

  • magnetic resonance angiography (MRA) of head, neck, and chest
  • cervical angiography
  • CT brain
  • MRI brain
More investigations to consider

Treatment algorithm


asymptomatic carotid stenosis <70%

asymptomatic carotid stenosis ≥70%: good surgical candidate

asymptomatic carotid stenosis ≥70%: poor surgical candidate



bilateral carotid stenosis

carotid restenosis



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



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.


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




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



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



JEI declares that he has no competing interests.

Jonathan D. Beard, ChM, Med, FRCS

Professor of Surgical Education

Consultant Vascular Surgeon

Sheffield Vascular Institute




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



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




CDL declares that he has no competing interests.

  • Carotid artery stenosis images
  • Differentials

    • Carotid dissection or subintimal hematoma
    • Thrombotic occlusion of the carotid artery resulting from plaque rupture
    • Fibromuscular dysplasia
    More Differentials
  • Guidelines

    • Screening for asymptomatic carotid artery stenosis
    • Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack
    More Guidelines
  • Patient leaflets

    Carotid artery stenosis: what is it?

    Carotid artery stenosis: what treatments work?

    More Patient leaflets
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