From the Research
Introduction to Carotid Artery Disease
Carotid artery disease is a significant cause of ischemic stroke, and patients with symptoms of stroke or transient ischemic attack attributable to a significantly stenotic vessel are at high risk for recurrent vascular events 1.
Causes and Risk Factors
The major risk factors for carotid artery stenosis include dyslipidemia, hypertension, diabetes, obesity, cigarette smoking, advanced glycation end products (AGEs) and its receptors (RAGE, soluble RAGE [sRAGE]), lack of exercise, and C-reactive protein (CRP) 2.
Key Risk Factors
- Dyslipidemia
- Hypertension
- Diabetes
- Obesity
- Cigarette smoking
- Advanced glycation end products (AGEs) and its receptors
- Lack of exercise
- C-reactive protein (CRP)
Preventive Measures
Preventive measures for carotid artery disease include lifestyle changes and medical treatment, such as:
- Initiation of antiplatelet agent or anticoagulation if medically indicated
- High potency statin medication
- Blood pressure control with goal blood pressure
- Mediterranean-style diet
- Exercise
- Smoking cessation 1, 2
Signs and Symptoms
Symptomatic carotid artery disease may present with symptoms of stroke or transient ischemic attack, while asymptomatic carotid artery stenosis may not have any noticeable symptoms.
Treatment Options
Treatment options for carotid artery disease include:
Medical Therapy
- Intensive medical therapy, including the use of dual antiplatelet therapy with aspirin and clopidogrel for the first 90 days following the ischemic event 1
- Lipid-lowering agents
- Antihypertensive agents
- Antidiabetic drugs
- Anti-AGE therapy
- Measures to elevate soluble receptors of AGE (sRAGE, esRAGE)
- CRP-lowering agents 2
Revascularization
- Carotid endarterectomy
- Carotid angioplasty and stenting, depending on several factors including the patient's anatomy, age, gender, and procedural risk 1
Dosing Information
- Aspirin and clopidogrel dosing may vary depending on the patient's condition and medical history
- Statin medication dosing may vary depending on the patient's condition and medical history
Differential Diagnosis and Caveats
- Patients with symptomatic intracranial stenosis should be managed with intensive medical therapy 1
- Patients with moderate stenosis of 50-69% may not benefit from revascularization with endarterectomy if the surgeon's risk of perioperative stroke or death rate is greater than 6% 1
- Diabetes mellitus is a risk factor for adverse outcomes after carotid endarterectomy or stenting, and modifying risk factors in DM patients may improve outcomes 3