Carotid artery stenosis refers to the narrowing or constriction of the carotid arteries, which supply blood to the brain, neck, and face
Aetiology
Carotid artery stenosis is most often caused by atherosclerosis, a condition in which fatty deposits, or plaques, build up in the arterial walls, leading to constriction and impaired blood flow
Other risk factors include age, hypertension, diabetes, smoking, and a history of vascular disease
Clinical features
The key signs and symptoms of carotid artery stenosis include those of an ischaemic event such as TIA or stroke in the corresponding vascular territory
Many patients may be asymptomatic until an ischaemic event occurs
Investigations
Duplex ultrasonography: this is the first line investigation and can evaluate blood flow and detect plaque in the carotid arteries
CT angiography and MR angiography: these can provide further details about the extent and severity of the stenosis
Management
Surgical
Patients should undergo carotid endarterectomy if there is carotid artery stenosis of 70-99%, with symptoms of an ischemic event such as a stroke or TIA in the corresponding vascular territory
Conservative
If patients do not meet the criteria for surgery:
Anti-platelet agents (first line is clopidogrel 75mg)