Management of Carotid Artery stenosis

Question 1

What do with asymptomatic carotid artery stenosis that is >80% stenosed?

Answer 1

carotid endarterectomy

Question 2

What do with asymptomatic carotid artery stenosis that is <80% stenosed?

Answer 2

medical management (aspirin, statin, antihypertensive medication)

Question 3

What do with a symptomatic carotid artery stenosis that is >70% stenosed?

Answer 3

carotid endarterectomy

Question 4

What do with a symptomatic carotid artery stenosis that is 50-69% stenosed?

Answer 4

male: carotid endarterectomy
female: medical management (ASA, statins, antihypertensives)

Question 5

What to do with a symptomatic carotid artery stenosis that is <50% stenosed?

Answer 5

medical management (ASA, statin, anti hypertensives)

Question 6

what should all patients with carotid artery atherosclerosis do?

Answer 6

stop smoking, get low dose aspirin, statin therapy and control of BP.

Question 7

Which patients would not benefit from a carotid endarterectomy or CEA?

Answer 7

• poor surgical candidates due to medical comorbidities,
• life expectancy <5 yrs,
• have ipsilateral stroke with persistent -disabiling neurological deficits

AND ppl who have complete occlusion of internal carotid artery

Question 8

What to do if person has complete 100% occlusion of internal carotid artery stenosis (regardless of symptomatic or asymptomatic)?

Answer 8

No benefit with carotid endarterectomy

In asymptomatic pts, complete occlusion of carotid artery typically indicates adequate collateral blood flow so unlikely to benefit from CEA.

Question 9

who gets carotid artery stenting?

Answer 9

PPL who are poor surgical candidates but may get benefit for revascularization.

Higher periprocedural stroke and mortability.

Sometimes done in failed CEA