Diagnosis of and treatment for symptomatic carotid stenosis: an updated review.

Abstract

Carotid stenoses of ≥50% account for about 15-20% of strokes. Their degree may be moderate (50-69%) or severe (70-99%). Current diagnostic methods include ultrasound, MR- or CT-angiography. Stenosis severity, irregular plaque surface, and presence of microembolic signals detected by transcranial Doppler predict the early recurrence risk, which may be as high as 20%. Initial therapy comprises antiplatelets and statins. Benefit of revascularization is greater in men, in older patients, and in severe stenosis; patients with moderate stenoses may also profit particularly if the plaque has an irregular aspect. An intervention should be performed within <2 weeks. In large randomized studies comparing endarterectomy and stenting, endovascular therapy was associated with a higher risk of periprocedural stroke, yet in some studies, with a lower risk of myocardial infarction and of cranial neuropathy. These trials support endarterectomy as the first choice treatment. Risk factors for each of the two therapies have been indentified: coronary artery disease, neck radiation, contralateral laryngeal nerve palsy for endarterectomy, and, elderly patients (>70 years), arch vessel tortuosity and plaques with low echogenicity on ultrasound for carotid stenting. Lastly, in direct comparisons, a contralateral occlusion increases the risk of periprocedural complications in both types of treatment.

• Authors: I Momjian-Mayor, P Burkhard, N Murith, D Mugnai, H Yilmaz, A-P Narata, K Lovblad, V Pereira, M Righini, H Bounameaux, R F Sztajzel
• Journal: Acta neurologica Scandinavica (Acta Neurol Scand) Vol. 126 Issue 5 Pg. 293-305 (Nov 2012) ISSN: 1600-0404 [Electronic] Denmark
• PMID: 22607370 (Publication Type: Journal Article, Review)
• Copyright: © 2012 John Wiley & Sons A/S.

Topics

• Carotid Stenosis (complications, diagnosis, therapy)
• Humans
• Stroke (etiology)