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Review
. 2005 Jul;51(7):984-9.

Management of carotid artery stenosis. Update for family physicians

George Louridas  1 , Asad Junaid
Affiliations
Review

Management of carotid artery stenosis. Update for family physicians

George Louridas et al. Can Fam Physician. 2005 Jul.

Abstract
in English, French

Objective: To clarify the definition of carotid artery diseases, the appropriateness of screening for disease, investigation and management of patients presenting with transient ischemic attacks, and management of asymptomatic carotid bruits. SOURCES OF INFORMATION MEDLINE: was searched using the terms carotid endarterectomy, carotid disease, and carotid stenosis. Most studies offer level II or III evidence. Consensus statements and guidelines from various neurovascular societies were also consulted.

Main message: Patients with symptoms of hemispheric transient ischemic attacks associated with >70% stenosis of the internal carotid artery are at highest risk of major stroke or death. Risk is greatest within 48 hours of symptom onset; patients should have urgent evaluation by a vascular surgeon for consideration of carotid endarterectomy (CEA). Patients with 50% to 69% stenosis might benefit from urgent surgical intervention depending on clinical features and associated comorbidity. Patients with <50% stenosis do not benefit from surgery. Asymptomatic patients with >60% stenosis should be considered for elective CEA.

Conclusion: Symptomatic carotid artery syndromes need urgent carotid duplex evaluation to determine the need for urgent surgery. Those with the greatest degree of stenosis derive the greatest benefit from timely CEA.

OBJECTIF: Clarifier la définition des maladies carotidiennes, les indications du dépistage, l’investigation et le traitement des épisodes d’ischémie transitoire, et le traitement des souffles carotidiens asymptomatiques.

SOURCE DE L’INFORMATION: Une recherche a été effectuée dans MEDLINE à l’aide des termes carotid endarterectomy, carotid disease et carotid stenosis. La plupart des études offrent des preuves de niveaux II et III. Les déclarations consensuelles et les directives de diverses associations neurovasculaires ont aussi été consultées.

PRINCIPAL MESSAGE: Les patients qui présentent des épisodes d’ischémie hémisphérique transitoire associés à une sténose de la carotide interne de >70% présentent le plus haut risque d’accident vasculaire cérébral et de mort. Ce risque est maximal dans les 48 heures suivant le début des symptômes; le patient doit être évalué d’urgence par un chirurgien vasculaire pour une éventuelle endartériectomie carotidienne (EC). Ceux qui ont une sténose entre 50 et 69% pourraient bénéficier d’une intervention chirurgicale urgente, selon les caractéristiques cliniques et la présence de comorbidité. Les sténoses de <50% n’ont pas avantage à être opérées. Dans les sténoses de >60%, une EC élective devrait être envisagée.

CONCLUSION: Les syndromes carotidiens symptomatiques requièrent une échographie bidimensionnelle rapide pour déterminer l’urgence d’intervenir. Les sténoses les plus serrées bénéficient le plus d’une EC faite à temps.

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Conflict of interest statement

Competing interests: None declared

Figures

Figure 1
Figure 1. Management of carotid artery stenosis
High-risk patients present with symptoms of motor weakness, speech deficit, hemispatial deficit, and hemianopia; low-risk patients present with only sensory deficit or amaurosis fugax.
See this image and copyright information in PMC

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