From the Guidelines
The recommended treatment for carotid artery stenosis is carotid endarterectomy (CEA) for symptomatic patients with 70%–99% internal carotid artery (ICA) stenosis, provided a documented 30-day risk of procedural death/stroke is <6% 1.
Key Considerations
- For symptomatic patients with 50%–69% ICA stenosis, CEA should be considered provided a documented 30-day risk of procedural death/stroke is <6% 1.
- Carotid artery stenting (CAS) is indicated as an alternative to CEA for symptomatic patients at average or low risk of complications associated with endovascular intervention when the diameter of the lumen of the internal carotid artery is reduced by >70% by noninvasive imaging or >50% by catheter angiography 1.
- Revascularization is not recommended in patients with ICA lesions <50% 1.
Medical Therapy
- All patients with symptomatic carotid stenosis should receive long-term antiplatelet therapy and statin therapy 1.
- Optimal medical therapy, which should include antiplatelet therapy, statin therapy, and risk factor modification, is recommended for all patients with carotid artery stenosis and a transient ischemic attack (TIA) or stroke 1.
Timing of Intervention
- When CEA is indicated for patients with TIA or stroke, surgery within 14 days is recommended rather than delaying surgery if there are no contraindications to early revascularization 1.
From the Research
Treatment Options for Carotid Artery Stenosis
The treatment for carotid artery stenosis depends on the severity of the stenosis and whether the patient is symptomatic or asymptomatic.
- Medical therapy, including antiplatelet therapy and aggressive treatment of vascular risk factors, is the mainstay of treatment for both symptomatic and asymptomatic patients 2, 3.
- For symptomatic patients with moderate- to high-grade stenosis, carotid endarterectomy (CEA) is effective in preventing ipsilateral ischemic events 3, 4.
- Carotid angioplasty and stenting (CAS) is also a valid alternative to CEA, but its safety and efficacy are still being studied 3, 5.
- For asymptomatic patients, the benefit of CEA or CAS is less clear, and the decision to intervene should be made on a case-by-case basis, considering factors such as the severity of stenosis, patient risk, and anatomy 3, 5, 6.
Medical Management
Medical management of carotid artery stenosis includes:
- Antiplatelet therapy to reduce the risk of embolic events 2, 5.
- Statins to reduce the risk of cardiovascular events 5.
- ACE inhibitors to control blood pressure and reduce the risk of cardiovascular events 5.
- Lifestyle modifications, such as stopping smoking, monitoring hypertension, hyperlipidemia, and diabetes, to control the processes associated with atheroma 2.
Surgical Management
Surgical management of carotid artery stenosis includes:
- Carotid endarterectomy (CEA) for symptomatic patients with moderate- to high-grade stenosis 3, 4.
- Carotid angioplasty and stenting (CAS) as a valid alternative to CEA, but its safety and efficacy are still being studied 3, 5.
- The choice of procedure may be influenced by anatomy, prior illness or treatment, or patient risk 5.