TY - CHAP M1 - Book, Section TI - Carotid Artery Disease A1 - White, Christopher J. A2 - Fuster, Valentin A2 - Narula, Jagat A2 - Vaishnava, Prashant A2 - Leon, Martin B. A2 - Callans, David J. A2 - Rumsfeld, John S. A2 - Poppas, Athena PY - 2022 T2 - Fuster and Hurst's The Heart, 15e AB - Chapter SummaryThis chapter discusses the epidemiology, natural history, diagnostic imaging modalities, and treatment options for atherosclerotic carotid artery disease as it relates to acute ischemic stroke. Significant atherosclerotic carotid artery disease (≥50% diameter stenosis) is common in Medicare patients (5%–10%); it is responsible for the vast majority of noncardioembolic acute strokes caused by plaque rupture with atheroembolization. Approximately 90% of the stroke risk is due to modifiable risk factors, such as hypertension, obesity, hyperglycemia, and hyperlipidemia, and 74% can be attributed to behavioral risk factors, such as tobacco smoking, sedentary lifestyle, and unhealthy diet. Doppler ultrasound (DUS) is the preferred noninvasive imaging tool for risk assessment of carotid disease, with cross-sectional multiplanar imaging [either computerized tomographic angiography (CTA) or magnetic resonance angiography (MRA)] reserved for specific cases. The cornerstone of therapy for stroke prevention in patients with carotid artery atherosclerotic disease is risk factor modification and guideline-directed medical therapy (GDMT), with revascularization (stent or surgery) indicated for selected symptomatic patients (see Fuster and Hurst’s Central Illustration). Current recommendations regarding revascularization in asymptomatic patients with significant carotid stenosis are uncertain and await the completion of an ongoing international randomized trial (CREST-2). SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/29 UR - accessmedicine.mhmedical.com/content.aspx?aid=1202444860 ER -