Risk Assessment of Critical Carotid Stenosis Treatment: Suggestions for Perioperative Management

Abstract

Carotid stenosis is typically caused by an atherosclerotic plaque that is most ­commonly found in the internal carotid artery at the point of bifurcation of the common carotid artery. It is classified as asymptomatic if there have been no ischemic events related to it, or symptomatic if there is a history of a stroke or transient ischemia attack (TIA). Carotid stenosis is evaluated by carotid ultrasound, magnetic resonance angiogram (MRA) with or without contrast, CT angiogram (CTA) or angiogram. MRA and ultrasound are typically screening tests, and CTA and/or angiogram are usually done before carotid endarterectomy (CEA) or carotid artery stenting (CAS) to accurately assess the degree of stenosis. Intervention is indicated for those with 70–99% stenosis but not for those with complete occlusion. It may be beneficial for those with 50–69% stenosis in centers known to have a very low surgical morbidity and mortality.