Carotid artery stenosis

- carotid artery disease accounts for 20% of stroke and TIAs

- 7.5% risk of stroke and death within 30days of endarterectomy

- there is no benefit to treat completely occluded vessel

Management

- Symptomatic patient < 50% stenosis : optimal medical therapy without revascularisation

- Asymptomatic patient < 60% stenosis : optimal medical therapy without revascularisation

- Symptomatic patient >= 50% stenosis : carotid endarterectomy with optimal medical therapy

- Asymptomatic patient >= 60% stenosis with low operative risk : carotid endarterectomy with optimal medical therapy

- Symptomatic patient >=50% stenosis with high operative risk : carotid stenting

- carotid artery stenting is inappropriate for asymptomatic patient with carotid artery stenosis. Possible exception may include patients with acceptable medical risk who present with severe carotid artery stenosis (>= 80%) with high anatomic risk for carotid endarterectomy but with compelling anatomy for stenting

Source: Clinical practice guideline for society of vascular surgery (J Vasc Surg 2008;48:480-6)