# carotid artery stenosis | Symptoms, Causes, Tests and Treatment | OSANG > Carotid artery stenosis is a condition in which atherosclerotic plaque accumulates in the carotid artery, narrowing the lumen of the blood vessel, and is one of the main… - Official page: https://osns.co.kr/en/encyclopedia/carotid-stenosis - Organization: OSANG Neurosurgery ## Page content Stroke ## carotid artery stenosis Carotid Artery Stenosis · I65.2 Carotid artery stenosis is a condition in which atherosclerotic plaques form in the internal carotid artery or common carotid artery, narrowing the vascular lumen, and is an important cause of cerebral infarction and transient ischemic attack (TIA). ## At a glance Carotid artery stenosis is a condition in which atherosclerotic plaque accumulates in the carotid artery, narrowing the lumen of the blood vessel, and is one of the main causes of cerebral infarction and TIA. For symptomatic stenosis of more than 70%, endarterectomy (CEA) or stenting (CAS) is recommended. The annual stroke risk of asymptomatic stenosis is approximately 1-2%, and medical management (antiplatelet drugs, statins, risk factor control) is the basis. Carotid ultrasound intima-media thickness (IMT) is used as an indicator of early atherosclerosis. - 01Definition and Overview - 02Cause/Pathophysiology - 03symptoms - 04diagnosis - 05treatment - 06prognosis ## Definition and Overview Carotid artery stenosis is a condition in which atherosclerotic plaques form in the internal carotid artery (ICA) or common carotid artery (CCA), narrowing the lumen of the blood vessel. It is an important cause of cerebral infarction and transient ischemic attack (TIA), and it is estimated that approximately 10-20% of all ischemic strokes are due to carotid artery stenosis. Stenosis is classified into symptomatic and asymptomatic depending on whether there are symptoms. The degree of stenosis is expressed as a percentage of the minimum internal diameter of the stenotic area compared to the normal internal diameter of the distal area, based on the North American Carotid Endarterectomy Study (NASCET). ## Cause/Pathophysiology The main cause of carotid artery stenosis is atherosclerosis. Risk factors such as high blood pressure, smoking, diabetes, and dyslipidemia cause damage to endothelial cells, and LDL cholesterol deposits on blood vessel walls to form plaques. When a blood clot forms in the plaque or the plaque ruptures unstablely, pieces of the clot block distal cerebral blood vessels, causing a TIA or cerebral infarction. Severe stenosis itself may reduce blood flow and cause cerebral infarction due to hypoperfusion. The carotid bifurcation is an area where blood flow shear stress is unevenly distributed and plaque formation is concentrated. ## symptoms Carotid artery stenosis often has no symptoms and is often discovered incidentally. Symptomatic stenosis causes TIA or cerebral infarction symptoms, such as amaurosis fugax in the ipsilateral eye, unilateral motor and sensory paralysis on the contralateral side, language impairment (in case of dominant hemisphere lesion), and hemifield disturbance. These symptoms are a medical emergency and require immediate evaluation. In asymptomatic stenosis, a carotid bruit is discovered incidentally during auscultation or imaging. The annual risk of stroke is approximately 1-2%. ## diagnosis Carotid duplex ultrasonography is a primary screening test that can measure the degree and location of stenosis, plaque properties, and carotid intima-media thickness (IMT). IMT is used as an early indicator of subclinical atherosclerosis. CT angiography (CTA) and MR angiography (MRA) precisely evaluate the scope and degree of stenosis and are used to plan surgery and procedures. Digital subtraction angiography (DSA) is invasive but is considered the gold standard for assessing the degree of stenosis. ## treatment The treatment policy is determined depending on the degree of stenosis, the presence or absence of symptoms, and the patient's general condition. The basic medical treatment includes antiplatelet drugs (aspirin, clopidogrel), statins (high-intensity LDL control), blood pressure control, blood sugar management, and smoking cessation. Most asymptomatic stenoses are managed with medical treatment. Carotid endarterectomy (CEA) is a standard surgery that has proven to be effective in preventing stroke compared to medical treatment alone in patients with symptomatic stenosis of more than 70% in the NASCET study. There may also be benefit in symptomatic patients with 50-69% stenosis. Carotid artery stenting (CAS) is considered an alternative to CEA in patients with high surgical risk (restenosis, history of radiation, anatomical high risk). CREST Research (2010), CEA and long-term results were similar. In cases of asymptomatic stenosis of 60% or more, the decision to perform the procedure is individualized considering life expectancy, procedure risk, and patient preference. ## prognosis The annual stroke risk of asymptomatic carotid artery stenosis is approximately 1-2%, and is often manageable with optimal medical treatment. Symptomatic severe stenosis requires prompt treatment as there is a high risk of stroke recurrence within 90 days after TIA or minor cerebral infarction. Major complications after CEA surgery include surgery-related stroke, myocardial infarction, and wound infection, and the complication rate of the procedure by an experienced surgeon is usually less than 3%. The long-term restenosis rate is approximately 5-10%. Continuous risk factor management and regular follow-up carotid ultrasound examination are important for improving long-term prognosis. --- This information is provided for medical educational purposes and is not a substitute for individual medical care or treatment. If you have any symptoms, be sure to seek professional advice. Inquiries: Osang Neurosurgery 1599-5453 | osns.co.kr ## Related articles - cerebral infarction - brain aneurysm - stroke - stroke risk factors This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.