Screening for asymptomatic carotid artery stenosis
- Mark O McCarron, MD, FRCP
Mark O McCarron, MD, FRCP
- Consultant Neurologist
- Altnagelvin Hospital
- Larry B Goldstein, MD, FAAN, FANA, FAHA
Larry B Goldstein, MD, FAAN, FANA, FAHA
- Professor and Chairman of Neurology
- Co-Director, Kentucky Neuroscience Institute
- KY Clinic - University of Kentucky
- David B Matchar, MD
David B Matchar, MD
- Professor of Medicine and Pathology
- Duke University Medical Center
- Director, Program in Health Services and Systems Research
- Duke-NUS Medical School
- Section Editors
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
The portions of the carotid artery most frequently affected by atherosclerosis are the proximal internal carotid artery (ie, the origin) and the carotid bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. This process can be asymptomatic, but may lead to ischemic stroke or transient ischemic attack from embolization, thrombosis, or hemodynamic compromise.
This topic will review screening for asymptomatic carotid atherosclerotic disease. The management of asymptomatic carotid disease is discussed separately. (See "Management of asymptomatic carotid atherosclerotic disease".)
Other aspects of carotid occlusive disease are reviewed elsewhere. (See "Pathophysiology of symptoms from carotid atherosclerosis" and "Evaluation of carotid artery stenosis" and "Management of symptomatic carotid atherosclerotic disease".)
Asymptomatic carotid atherosclerotic disease refers to the presence of atherosclerotic narrowing of the extracranial internal carotid artery in individuals without a history of ipsilateral carotid territory ischemic stroke or transient ischemic attack (TIA) [1-3].
Symptomatic carotid disease is defined as focal neurologic symptoms (eg, amaurosis fugax, contralateral weakness or numbness of an extremity or the face, dysarthria or aphasia) in the distribution of a carotid artery with a significant stenosis. Atherosclerotic carotid disease is considered symptomatic if the ipsilateral symptoms occurred within the previous six months. Importantly, nonspecific neurologic symptoms (eg, dizziness, lightheadedness) are not indicative of carotid stenosis. Therefore, patients with these symptoms in isolation should be considered as asymptomatic with regard to carotid disease even if they are found to have carotid artery stenosis. (See "Management of symptomatic carotid atherosclerotic disease", section on 'Definition of symptomatic disease'.)
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