[Update carotid artery stenosis]

Area of Science:

• Vascular Surgery
• Neurology
• Cardiology

Background:

• Extracranial carotid artery stenosis is a significant, treatable cause of ischemic stroke.
• Vascular ultrasound reliably detects and grades carotid artery stenosis.
• Therapeutic decisions depend on stenosis severity, symptoms, surgical risk, and life expectancy.

Purpose of the Study:

• To outline current therapeutic strategies for extracranial carotid artery stenosis.
• To differentiate treatment approaches for symptomatic versus asymptomatic stenosis.
• To review the roles of conservative management, carotid endarterectomy, and endovascular therapy.

Main Methods:

• Literature review of diagnostic and therapeutic modalities for carotid artery stenosis.
• Analysis of treatment guidelines for symptomatic and asymptomatic carotid artery stenosis.
• Evaluation of outcomes for carotid endarterectomy and endovascular stenting.

Main Results:

• Optimal medical management includes risk factor control and antiplatelet therapy.
• Carotid endarterectomy is effective for high-grade symptomatic stenosis.
• Endovascular therapy offers an alternative for high-risk patients with low complication rates in experienced centers.
• Asymptomatic stenosis is primarily managed conservatively; revascularization is considered for select low-risk patients.

Conclusions:

• Treatment of extracranial carotid artery stenosis requires individualized risk assessment.
• Both surgical and endovascular revascularization are effective stroke prevention strategies in selected patients.
• Conservative management remains the cornerstone for asymptomatic carotid artery stenosis.