RT Book, Section
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
SR Print(0)
ID 1202444860
T1 Carotid Artery Disease
T2 Fuster and Hurst's The Heart, 15e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264257560
LK accessmedicine.mhmedical.com/content.aspx?aid=1202444860
RD 2024/10/12
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).