Carotid artery stenosis

Prognosis is related to the degree of carotid stenosis.[25]Grotta JC. Clinical practice. Carotid stenosis. N Engl J Med. 2013 Sep 19;369(12):1143-50. http://www.ncbi.nlm.nih.gov/pubmed/24047063?tool=bestpractice.com ​ Patients with asymptomatic carotid stenosis 70% or less managed with pharmacologic therapy demonstrate progression to high-grade stenosis at a generally modest rate of no more than 5% per year. Carotid artery revascularization is effective in preventing stroke, and around 1% of patients per year have a stroke after carotid endarterectomy or stenting.[53]Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-1428. http://www.ncbi.nlm.nih.gov/pubmed/7723155?tool=bestpractice.com Both carotid endarterectomy and stenting are anatomically durable procedures, and restenosis occurs in approximately 6% of patients over 2 years after either procedure.[54]Lal BK, Beach KW, Roubin GS, et al. Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol. 2012;11:755-763. http://www.ncbi.nlm.nih.gov/pubmed/22857850?tool=bestpractice.com Patients must be followed clinically and with a noninvasive duplex ultrasound exam on an annual basis. In some other countries, annual surveillance is not recommended.

Carotid stenosis is also a marker for atherosclerosis elsewhere in the vascular tree. Appropriate and aggressive identification and management of hypertension, hypercholesterolemia, and smoking cessation must continue lifelong after treatment for carotid stenosis.