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Management of Patients With Atherosclerotic Carotid Occlusion

  • Cerebrovascular Disorders (Harold P. Adams Jr., Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

• Patients with acute ischemic stroke due to atherosclerotic carotid artery occlusion (ACAO) should receive intravenous tissue plasminogen activator (alteplase) if they meet eligibility criteria of the National Institute of Neurological Disorders and Stroke (NINDS) or the European Cooperative Acute Stroke Study III (ECASS III). • Patients with acute stroke due to ACAO who are not eligible for intravenous tissue plasminogen activator should receive aspirin. Heparin or heparin-like drugs do not improve outcome and should not be used. • Therapy for prevention of recurrent stroke in patients with ACAO should consist of lifestyle modifications, risk factor intervention, and antiplatelet drugs. Warfarin is not indicated. • Extracranial-intracranial bypass surgery provides no benefit over medical therapy in preventing recurrent stroke in a general population of patients with ACAO or in any subgroups selected by clinical, arteriographic, or hemodynamic criteria. • Other surgical or endovascular procedures have no proven value in treating or preventing stroke due to ACAO. • Asymptomatic carotid occlusion has a benign prognosis and requires no specific treatment other than lifestyle modification and risk factor intervention.

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Acknowledgment

This research was supported by USPHS grant NS 42167.

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Department of Neurology, University of North Carolina at Chapel Hill, Box 7025, Room 2131, 170 Manning Drive, Chapel Hill, NC, 27599, USA

    William J. Powers MD

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  1. William J. Powers MD
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Correspondence to William J. Powers MD.

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Powers, W.J. Management of Patients With Atherosclerotic Carotid Occlusion. Curr Treat Options Neurol 13, 608–615 (2011). https://doi.org/10.1007/s11940-011-0145-6

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