Carotid artery stenosis overview

Carotid artery stenosis Microchapters
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Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Carotid artery stenosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Testing Guidelines
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ACC/AHA Guideline Recommendations
Diagnostic Testing Guidelines Recommendation
Primary Prevention and Screening Guidelines Recommendations
Secondary Prevention Guidelines Recommendations
Selection of Patients for Carotid Revascularization
Periprocedural Management of Patients Undergoing Carotid Endarterectomy
Management of Patients Undergoing Carotid Artery Stenting
Restenosis After Carotid Endarterectomy or Stenting
Vascular Imaging in Patients With Vertebral Artery Disease
Atherosclerotic Risk Factors in Patients With Vertebral Artery Disease
Occlusive Disease of the Subclavian and Brachiocephalic Arteries
Fibromuscular Dysplasia
Cervical Artery Dissection
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Case #1
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Carotid arterial stenosis is a narrowing of the lumen of the carotid artery, usually by atheroma (a fatty lump or plaque causingatherosclerosis). Atheroma's may cause transient ischemic attacks (TIAs) and cerebrovascular accidents (CVAs) as it obstructs the bloodstream to the brain. It also has the potential to generate emboli (blood clots) that obstruct the cerebral arteries.

The narrowing can either be asymptomatic (causing no medical problems) or presents with symptoms such as TIAs and CVAs.

Pathophysiology

Embolism of atherosclerotic lesions in the carotid is the most common mechanism of stroke in patients with carotid artery disease. Thrombosis of the cerebral arteries is also a possible, less common cause of stroke.

Causes

The most common cause of carotid artery stenosis is atherosclerosis. The process of atherosclerotic plaque formation starts in the early adulthood but it takes years for it to cause symptoms. Uncommon causes include Marfan's syndrome and fibromuscular dysplasia.

Risk Factors

Risk factors for carotid artery stenosis are almost similar to those for cerebrovascular accident (CVA), coronary heart disease (ACS) and peripheral vascular disease (PVD). Common risk factors include hypertension, smoking, advanced age and abnormal cholesterol levels including lowered HDL levels in the blood.

Screening

Screening for carotid disease is done before cardiac surgery.

Diagnosis

EKG

The EKG may show evidence of an old infarct or myocardial ischemia. The most common cause of death post-CEA is a myocardial infarction.

References

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