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Carotid Artery Disease

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Comprehensive Cardiovascular Medicine in the Primary Care Setting

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Stroke is one of the leading causes of morbidity and mortality in North America, affecting over half a million patients at a cost of over $30 billion a year. Depending on the population studied, extracranial internal carotid artery stenosis accounts for approximately 10–15% of ischemic strokes. Aside from these symptomatic cases, large population-based studies indicate that the prevalence of asymptomatic carotid artery stenosis is approximately 0.5% in the sixth decade and increases up to 10% in persons over 80 years of age (1).

Key Points

• In patients with carotid artery stenosis, risk factors such as hypertension, diabetes mellitus, hyperlipedemia, and smoking should be evaluated and treated aggressively.

• The use of prophylactic aspirin is recommended in all patients with carotid artery stenosis.

• Patients with an asymptomatic carotid stenosis should be educated about possible symptoms of transient ischemic attacks and should immediately contact a physician in case a transient ischemic attack occurs.

• In patients with an asymptomatic carotid stenosis, prophylactic carotid endarterectomy (CEA) can be recommended only in highly selected patients with high-grade stenosis performed by surgeons with established perioperative morbidity and mortality rates of <3%. With regard to carotid angioplasty and stenting (CAS), there is currently insufficient data to properly guide treatment decisions. If considered, CAS should be performed only by operators with established perioperative morbidity and mortality rates of <3%.

• Carotid endarterectomy should be considered in patients with recent TIA or ischemic stroke within the last 6 months and ipsilateral severe (>70%) carotid artery stenosis. In patients with recent symptomatic moderate (50–69%) carotid stenosis, CEA should be considered in men, in patients older than 74 years of age, and in patients with hemispheric symptoms rather than transient monocular blindness. CEA should be performed only by surgeons with established perioperative morbidity and mortality rates of <6%.

• In patients with a recently symptomatic carotid artery stenosis, surgery should ideally be performed within 2 weeks.

• Carotid angioplasty and stenting may be considered in symptomatic patients with severe (>70%) carotid artery stenosis, in whom the stenosis is difficult to access surgically, in whom medical conditions are present that greatly increase the risk for surgery, or in patiencats with restenosis after CEA or radiation-induced stenosis. CAS should be performed only by operators with established perioperative morbidity and mortality rates of <6%.

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Author information

Authors and Affiliations

  1. Departments of Neurology, Klinikum Bremen-Ost and Klinikum Bremen-Mitte, Bremen, Germany

    Andreas Kastrup MD

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  1. Andreas Kastrup MD
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Editors and Affiliations

  1. Sterling Rock Falls Clinic, 101 E. Miller Road, Sterling, 61081, USA

    Peter P. Toth

  2. Brigham & Women's Hospital, Cardiovascular Division, Harvard Medical School, Longwood Ave. 350, Boston, 02115, USA

    Christopher P. Cannon

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Kastrup, A. (2011). Carotid Artery Disease. In: Toth, P., Cannon, C. (eds) Comprehensive Cardiovascular Medicine in the Primary Care Setting. Contemporary Cardiology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-963-5_15

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  • DOI: https://doi.org/10.1007/978-1-60327-963-5_15

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-962-8

  • Online ISBN: 978-1-60327-963-5

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