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Diagnosis and management of patients with asymptomatic carotid artery bruit

W S Moore1

  • 1UCLA School of Medicine, Department of Surgery 90024-6094.

Comprehensive Therapy
|June 1, 1990
PubMed

Insights

Asymptomatic carotid artery lesions, particularly those with soft plaque or ulcerations, pose a significant stroke risk. Prophylactic carotid endarterectomy is recommended for critical lesions if surgical risk is below 3% while awaiting study results.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiology

Background:

  • Asymptomatic lesions account for approximately 150,000 strokes annually in the U.S.
  • Carotid bifurcation atherosclerotic plaques compromising 75% or more of the lumen, especially soft plaques or those with ulcerations, indicate high stroke risk.

Purpose of the Study:

  • To evaluate the risk-benefit profile of surgical intervention for asymptomatic carotid artery lesions.
  • To provide guidance on prophylactic carotid endarterectomy in the interim period before definitive study results are available.

Main Methods:

  • Review of existing data on stroke risk associated with asymptomatic carotid lesions.
  • Analysis of perioperative morbidity and mortality rates for carotid endarterectomy in asymptomatic patients.

Main Results:

  • Carotid endarterectomy for asymptomatic critical lesions has a combined morbidity and mortality risk averaging less than 1%.
  • Two ongoing randomized prospective studies are comparing medical versus surgical management.

Conclusions:

  • Prophylactic carotid endarterectomy is justified for critical asymptomatic lesions when surgeon's combined morbidity and mortality risk is less than 3%.
  • Clinical decision-making should consider individual patient factors and surgeon expertise pending results from ongoing trials.

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