Extracranial carotid artery. Current concepts of diagnosis and management

Area of Science:

• Neurology
• Vascular Surgery
• Cardiology

Background:

• Extracranial carotid artery disease is a significant cause of transient ischemic attack (TIA), accounting for approximately 50% of cases.
• It is a less common cause of cerebral infarction, responsible for about 15% of strokes.
• TIAs typically precede strokes from extracranial carotid stenosis, unlike those from cardiogenic embolism or intracranial disease.

Purpose of the Study:

• To review the mechanisms, clinical presentation, and management of extracranial carotid artery disease.
• To discuss stroke risk in patients undergoing surgery with significant carotid stenosis.
• To highlight the importance of stroke prevention strategies, particularly smoking cessation.

Main Methods:

• Literature review and synthesis of existing data on extracranial carotid artery disease.
• Analysis of stroke risk associated with asymptomatic carotid stenosis during surgical procedures.
• Evaluation of treatment options for symptomatic carotid stenosis.

Main Results:

• Artery-to-artery embolism is the primary mechanism for TIAs and strokes in extracranial carotid stenosis.
• General surgery does not increase stroke risk, but cardiovascular operations may increase risk in patients with critical carotid stenosis (>90%).
• Perioperative strokes are commonly caused by embolism rather than hemodynamic changes.

Conclusions:

• Carotid endarterectomy is the preferred treatment for symptomatic high-grade (>70%) stenosis in non-high-risk patients.
• Ticlopidine and percutaneous angioplasty show promise for high-risk patients.
• Eliminating cigarette smoking, a major risk factor, is crucial for preventing extracranial carotid disease and subsequent strokes.