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Carotid Stenosis

Naureen Rafiq, MD and Austin Saavedra, MD Reviewed 06/2018
 


BASICS

Carotid stenosis may be caused by atherosclerosis, intimal fibroplasia, vasculitis, adventitial cysts, or vascular tumors; atherosclerosis is the most common etiology. 

DESCRIPTION

  • Narrowing of t...

DIAGNOSIS

Screening for carotid stenosis is not recommended. However, in the setting of symptoms suggestive of stroke or TIA, workup for this condition may be indicated. 

HISTORY

  • Identification of modif...

TREATMENT

Smoking cessation, BP control, blood glucose control, antiplatelet medication, and statin medication are the primary treatments for both asymptomatic and symptomatic carotid stenosis. 

GENERAL MEASURES

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Patient Monitoring

  • Duplex at 2 to 6 weeks postoperatively

  • Duplex every 6 to 12 months

  • Reoperative CEA or CAS is reasonable, if there is rapidly progressive restenosi...

REFERENCES

1
Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev.  2017;(6):CD001081. [View Abstract on OvidMedline]
2
Chaturvedi S, Bruno A, ...

ADDITIONAL READING

  • Go C, Avgerinos ED, Chaer RA, et al. Long-term clinical outcomes and cardiovascular events after carotid endarterectomy. Ann Vasc Surg.  2015;29(6):1265–1271. [View Abstract o...

SEE ALSO

Algorithms: Stroke; Transient Ischemic Attack and Transient Neurologic Defects 

CODES

ICD10

  • I65.29 Occlusion and stenosis of unspecified carotid artery

  • I65.21 Occlusion and stenosis of right carotid artery

  • I65.22 Occlusion and stenosis of left carotid artery

  • I65.23 Occlusion and sten...

CLINICAL PEARLS

  • Atherosclerosis is responsible for 90% of all cases of carotid artery stenosis.

  • Duplex US is the best initial imaging modality.

  • Antiplatelet therapy and aggressive treatment of vascular ...

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