Assessment and management of carotid disease

Recent reports of results of clinical trials comparing carotid endarterectomy with medical treatment for carotid stenosis have clarified the relationship of extracranial carotid stenosis to symptomatic cerebrovascular disease. Results of these trials emphasize the importance of severity of carotid stenosis in therapeutic decision making. In addition, however, presence of carotid stenosis identifies individuals with an excess burden of cardiovascular disease risk factors and atherosclerosis of other (e.g. coronary) arteries. In parallel with growing awareness of the clinical relevance of extracranial carotid stenosis, new population-based studies and studies in symptomatic populations are defining the risk factors for extracranial carotid atherosclerosis and atherosclerosis progression. These new investigative approaches promise to increase substantially our understanding of the pathogenesis and clinical consequences of cerebrovascular disease in the forthcoming years.