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Evaluation of carotid artery stenosis

Karen L Furie, MD, MPH
Section Editors
Scott E Kasner, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
John F Dashe, MD, PhD


Computed tomographic (CT) scanning and magnetic resonance imaging (MRI) are useful for evaluating the question of cerebral infarction which may result from carotid artery stenosis. Infarctions related to internal carotid artery stenosis may be deep, subcortical, or cortical. However, carotid stenosis may exist in the absence of infarction on MRI and CT.

The definition of asymptomatic or symptomatic carotid artery stenosis is based upon the history and physical examination, depending upon whether or not there are symptoms or signs of carotid territory ischemia. In the large clinical trials addressing the management of carotid artery stenosis, the detection of "silent" infarcts on CT or MRI did not qualify the stenosis as symptomatic. In clinical practice, however, radiographic evidence of ischemia in the territory of a stenotic internal carotid artery may affect management.

Four diagnostic modalities are used to directly image the internal carotid artery:

Cerebral angiography

Carotid duplex ultrasound

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Literature review current through: Nov 2017. | This topic last updated: Dec 30, 2016.
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