[Carotid artery stenosis : from diagnosis to treatment]

Carotid atherosclerosis is a major cause of ischemic stroke. The risk of stroke depends on both the degree of stenosis and the high-risk plaque morphological features, particularly intraplaque hemorrhage. Identifying these markers improves risk stratification beyond the degree of stenosis alone and helps select patients who are most likely to benefit from revascularization. The management of carotid stenosis, both symptomatic and asymptomatic, has evolved considerably. Advances in medical therapy, including strict control of vascular risk factors, antiplatelet agents, and lipid-lowering treatments, have reduced the risk of ipsilateral stroke in contemporary cohorts, thereby limiting the absolute benefit of surgical interventions to carefully selected cases.