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Carotid artery stenosis

Last reviewed: 21 Oct 2024
Last updated: 04 Jun 2024

Summary

Definition

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])
Full details

Other diagnostic factors

  • transient visual symptoms
Full details

Risk factors

  • older age
  • smoking
  • history of cardiovascular disease
  • history of hypertension
  • history of hypercholesterolemia
  • diabetes
Full details

Diagnostic tests

1st tests to order

  • duplex ultrasonography
  • computed tomography angiography (CTA) of head, neck, and chest
Full details

Tests to consider

  • magnetic resonance angiography (MRA) of head, neck, and chest
  • CT brain
  • MRI brain
Full details

Treatment algorithm

ACUTE

asymptomatic carotid stenosis <70%

asymptomatic carotid stenosis ≥70%: good surgical candidate

asymptomatic carotid stenosis ≥70%: poor surgical candidate

symptomatic

ONGOING

bilateral carotid stenosis

carotid restenosis

Contributors

Authors

Brajesh K. Lal, MD, FACS

Professor of Vascular Surgery

University of Maryland School of Medicine

Professor of Neurology

Mayo Clinic

Chief of the Vascular Service

Baltimore VA Medical Center

Baltimore

MD

Disclosures

BKL declares that he has a grant from the National Institutes of Health, Bethesda, MD, USA to conduct a multicenter study comparing revascularization to medical management for asymptomatic carotid stenosis.

​​Richard Bulbulia, MA, MD, FRCS

Associate Professor and Consultant Vascular Surgeon

Clinical Trial Service Unit and MRC Population Health Research Unit

Nuffield Department of Population Health

University of Oxford

Oxford

UK

Disclosures

RB declares that he has no competing interests.

Acknowledgements

Dr Brajesh K Lal and Dr Richard Bulbulia would like to gratefully acknowledge Professor Martin M Brown, a previous contributor to this topic.

Peer reviewers

Tristan RA Lane, ​MBBS, BSc, PhD, FRCS

Consultant Vascular Surgeon

Cambridge Vascular Unit

Addenbrooke's Hospital

Cambridge University Hospital Trust

Cambridge

Honorary Senior Clinical Lecturer, Section of Vascular Surgery

Department of Surgery and Cancer

Imperial College London

UK

Disclosures

TRAL declares that he has no competing interests.

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  • Guidelines

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    • European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease
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  • Patient information

    Carotid artery stenosis: what is it?

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