Management
Options include:
- Medications alone (an antiplatelet drug (or drugs) and control of risk factors for atherosclerosis)
- Medical management plus carotid endarterectomy or carotid stenting
The goal of treatment is to reduce the risk of stroke (cerebrovascular accident). Intervention (carotid endarterectomy or carotid stenting) can cause stroke, however where the risk of stroke from medical management alone is high, intervention may be beneficial. In selected, high-risk trial participants with asymptomatic severe carotid artery stenosis, carotid endarterectomy by selected surgeons reduces the 5-year absolute incidence of all strokes or perioperative death by approximately 5%. In excellent centers, carotid endarterectomy is associated with a 30-day stroke or mortality rate of about 3%; some areas have higher rates.
Clinical guidelines (such as those of National Institute for Clinical Excellence (NICE)) recommend that all patients with carotid stenosis be given medication, usually anti-hypertensive drugs, anti-clotting drugs, anti-platelet drugs (such as aspirin), and especially statins (which were originally prescribed for their cholesterol-lowering effects but were also found to reduce inflammation and stabilize plaque).
NICE and other guidelines also recommend that patients with symptomatic carotid stenosis be given carotid endarterectomy urgently, since the greatest risk of stroke is within days. Carotid endarterectomy reduces the risk of stroke or death from carotid emboli by about half.
For people with stenosis but no symptoms, the surgical recommendations are less clear and controversial. Such patients have a historical risk of stroke of about 1-2% per year. Carotid endarterectomy has a surgical risk of stroke or death of about 2-4% in the best institutions. Carotid endarterectomy reduced major stroke and death by about half, even after surgical death and stroke was taken into account. According to the Cochrane Collaboration the absolute benefit of surgery is small.
Read more about this topic: Carotid Artery Stenosis
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