Related Experiment Videos
[Diagnosis and treatment of symptomatic and asymptomatic carotid disease]
1Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina. cjestol@infovia.com.ar
Objective:
Provide a management strategy for the evaluation and treatment of extracranial internal carotid artery disease.
Background:
Despite 50 years that have elapsed since the first carotid artery endarterectomy, surgical indications in symptomatic and asymptomatic carotid artery disease remain controversial.
Design:
The most important studies on the treatment of symptomatic and asymptomatic internal carotid artery disease were reviewed. Special scenarios were analyzed including: intraluminal thrombus, carotid artery occlusion, dissection, ulceration, fibromuscular dysplasia, re-stenosis post endarterectomy and carotid artery disease coexisting with coronary artery disease. The current status of carotid angioplasty was discussed briefly.
Conclusions:
A patient-individualized approach based on the aforementioned studies and personal experience is provided. Endarterectomy is recommended in greater than 70% ICA symptomatic stenosis, in certain patients with 50 to 69% symptomatic stenosis, and exceptionally in asymptomatic patients, patients with associated coronary artery disease, ulceration, intraluminal thrombus and other less frequent scenarios.