Carotid stenosis - Revision history

Danbot: Expand with concise EM-focused content: clinical features, evaluation, medical and surgical management

2026-03-21T01:14:16Z

Expand with concise EM-focused content: clinical features, evaluation, medical and surgical management

← Older revision		Revision as of 01:14, 21 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*~~Among patients who suffer~~ [[stroke]], ~~50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9~~, ~~2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref~~>		*Narrowing of internal carotid artery, usually from atherosclerotic plaque
			*Responsible for 10-20% of ischemic [[stroke\|strokes]] and [[TIA\|TIAs]]
			*Risk factors: [[hypertension]], [[diabetes]], smoking, [[hyperlipidemia]], age >65

	==Clinical Features==		==Clinical Features==
			*Often asymptomatic until [[stroke]] or [[TIA]] occurs
	~~==Differential Diagnosis==~~		*'''Symptomatic carotid stenosis:'''
			**Anterior circulation TIA or stroke (ipsilateral to stenosis)
			**[[Amaurosis fugax]] (transient monocular vision loss) — classic for carotid disease
			**Hemispheric symptoms: contralateral [[weakness]], [[numbness]], [[aphasia]]
			*Carotid bruit on exam (low sensitivity and specificity — absence does NOT rule out stenosis)

	==Evaluation==		==Evaluation==
			*Carotid duplex ultrasound — first-line screening study
			*CT angiography (CTA) or MR angiography (MRA) for definitive assessment
			*Standard stroke workup if presenting with TIA/stroke: [[CT]] head, [[ECG]], labs
			*Screen for concurrent coronary artery disease (high comorbidity)

	==Management==		==Management==
	===~~Carotid Endarterectomy~~===		===Medical Therapy (All Patients)===
	*~~Indicated in symptomatic patients fulfilling the following~~:		*[[Antiplatelet therapy]]: aspirin or clopidogrel
	**<6% surgical morbidity/mortality		*[[Statin]] therapy (high-intensity)
	**≥1 [[~~TIA~~]](s) ~~in past 6 months~~		*Blood pressure control, [[diabetes]] management, smoking cessation
	**~~Carotid artery~~ stenosis ~~> 50~~%
	*~~Indicated~~ in ~~asymptomatic~~ patients with:		===Surgical/Interventional===
	**~~<3% surgical morbidity/mortality~~		*'''Carotid endarterectomy (CEA):'''
	**Carotid artery ~~stenosis > 60%~~		**Symptomatic stenosis ≥50-70%: Strong benefit from CEA (NNT ~6 for 70-99%)
			**Asymptomatic stenosis ≥60-80%: Modest benefit in select patients with good surgical risk
			**Should be performed within 2 weeks of index event for maximal benefit
			*'''Carotid artery stenting (CAS):''' Alternative for high surgical risk patients
			*'''Near-occlusion or complete occlusion:''' Medical management preferred (surgery not beneficial)

	==Disposition==		==Disposition==
			*New symptomatic carotid stenosis (TIA/stroke) — admit for stroke workup, expedited surgical evaluation
			*Incidental asymptomatic stenosis — outpatient vascular surgery referral

	==See Also==		==See Also==
	*[[Stroke]]		*[[Stroke]]
			*[[TIA]]
			*[[Amaurosis fugax]]
			*[[Carotid artery dissection]]

	==References==		==References==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T19:20:46Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 19:20, 22 July 2016
Line 6:		Line 6:
	==Differential Diagnosis==		==Differential Diagnosis==

	==~~Diagnosis~~==		==Evaluation==

	==Management==		==Management==

Rossdonaldson1 at 20:30, 4 July 2016

2016-07-04T20:30:45Z

← Older revision		Revision as of 20:30, 4 July 2016
Line 2:		Line 2:
	*Among patients who suffer [[stroke]], 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>		*Among patients who suffer [[stroke]], 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>

	==Carotid Endarterectomy==		==Clinical Features==

			==Differential Diagnosis==

			==Diagnosis==

			==Management==
			===Carotid Endarterectomy===
	*Indicated in symptomatic patients fulfilling the following:		*Indicated in symptomatic patients fulfilling the following:
	**<6% surgical morbidity/mortality		**<6% surgical morbidity/mortality
Line 10:		Line 17:
	**<3% surgical morbidity/mortality		**<3% surgical morbidity/mortality
	**Carotid artery stenosis > 60%		**Carotid artery stenosis > 60%

			==Disposition==

			==See Also==
			*[[Stroke]]

	==References==		==References==
Line 15:		Line 27:

	[[Category:Neurology]]		[[Category:Neurology]]
			[[Category:Vascular]]

Neil.m.young: Text replacement - "==Sources==" to "==References=="

2016-06-26T06:43:59Z

Text replacement - "==Sources==" to "==References=="

← Older revision		Revision as of 06:43, 26 June 2016
Line 11:		Line 11:
	**Carotid artery stenosis > 60%		**Carotid artery stenosis > 60%

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:Neurology]]		[[Category:Neurology]]

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:49:38Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:49, 21 June 2016
Line 1:		Line 1:
	==Background==		==Background==
	*Among ~~pts~~ who suffer [[stroke]], 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>		*Among patients who suffer [[stroke]], 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>

	==Carotid Endarterectomy==		==Carotid Endarterectomy==
	*Indicated in symptomatic ~~pts~~ fulfilling the following:		*Indicated in symptomatic patients fulfilling the following:
	**<6% surgical morbidity/mortality		**<6% surgical morbidity/mortality
	**≥1 [[TIA]](s) in past 6 months		**≥1 [[TIA]](s) in past 6 months
	**Carotid artery stenosis > 50%		**Carotid artery stenosis > 50%
	*Indicated in asymptomatic ~~pts~~ with:		*Indicated in asymptomatic patients with:
	**<3% surgical morbidity/mortality		**<3% surgical morbidity/mortality
	**Carotid artery stenosis > 60%		**Carotid artery stenosis > 60%

Perobinson: /* Carotid Endarterectomy */

2016-06-16T18:43:42Z

Carotid Endarterectomy

← Older revision		Revision as of 18:43, 16 June 2016
Line 5:		Line 5:
	*Indicated in symptomatic pts fulfilling the following:		*Indicated in symptomatic pts fulfilling the following:
	**<6% surgical morbidity/mortality		**<6% surgical morbidity/mortality
	**≥1 TIA(s) in past 6 months		**≥1 [[TIA]](s) in past 6 months
	**Carotid artery stenosis > 50%		**Carotid artery stenosis > 50%
	*Indicated in asymptomatic pts with:		*Indicated in asymptomatic pts with:

Perobinson: /* Background */

2016-06-16T18:43:20Z

Background

← Older revision		Revision as of 18:43, 16 June 2016
Line 1:		Line 1:
	==Background==		==Background==
	*Among pts who suffer stroke, 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>		*Among pts who suffer [[stroke]], 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>

	==Carotid Endarterectomy==		==Carotid Endarterectomy==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:02Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:14, 22 March 2016
Line 14:		Line 14:
	<references/>		<references/>

	[[Category:~~Neuro~~]]		[[Category:Neurology]]

Kxl328 at 19:09, 18 February 2016

2016-02-18T19:09:59Z

← Older revision		Revision as of 19:09, 18 February 2016
Line 12:		Line 12:

	==Sources==		==Sources==
	</~~references~~>		<references/>

	[[Category:Neuro]]		[[Category:Neuro]]

Kxl328: Created page with "==Background== *Among pts who suffer stroke, 50-75% could have been treated with endarterectomyHaqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://eme..."

2016-02-18T19:09:28Z

Created page with "==Background== *Among pts who suffer stroke, 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://eme..."

New page

==Background==
*Among pts who suffer stroke, 50-75% could have been treated with endarterectomy<ref>Haqqani O et al. Carotid Endarterectomy. eMedicine. Dec 9, 2014. http://emedicine.medscape.com/article/1895291-overview#showall.</ref>

==Carotid Endarterectomy==
*Indicated in symptomatic pts fulfilling the following:
**<6% surgical morbidity/mortality
**≥1 TIA(s) in past 6 months
**Carotid artery stenosis > 50%
*Indicated in asymptomatic pts with:
**<3% surgical morbidity/mortality
**Carotid artery stenosis > 60%

==Sources==
</references>

[[Category:Neuro]]