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Management of asymptomatic carotid atherosclerotic disease

Ronald M Fairman, MD
Section Editors
Scott E Kasner, MD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editors
John F Dashe, MD, PhD
Kathryn A Collins, MD, PhD, FACS


The locations most frequently affected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Progression of atheromatous plaque at the carotid bifurcation results in luminal narrowing, often accompanied by ulceration. This process can lead to ischemic stroke or transient ischemic attack from embolization, thrombosis, or hemodynamic compromise.

This topic will review the treatment of asymptomatic extracranial carotid atherosclerotic disease. The management of symptomatic extracranial carotid disease is discussed separately. (See "Management of symptomatic 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 "Carotid endarterectomy" and "Intracranial large artery atherosclerosis".)


Asymptomatic carotid atherosclerotic disease refers to the presence of atherosclerotic narrowing of the extracranial internal carotid artery in individuals without a history of recent ipsilateral carotid territory ischemic stroke or transient ischemic attack (TIA).

In contradistinction, symptomatic carotid disease is defined as focal neurologic symptoms caused by TIAs or ischemic stroke in the carotid artery territory and ipsilateral to significant carotid atherosclerotic pathology. Although there is no precise time constraint, atherosclerotic carotid disease is considered symptomatic if carotid symptoms occurred within the previous six months. Thus, remote carotid symptoms are not considered as indicative of symptomatic carotid disease.

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2017.
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