title: Carotid occlusive disease: primary care of patients with or without symptoms.
abstract: Of the half-million strokes that occur each year in the United States, 20 to 30% can be directly linked to carotid occlusive disease. The degree of stenosis involving the carotid bifurcation is an important predictor of stroke risk. Asymptomatic disease may be diagnosed on routine physical exam or screening of the carotid bifurcation in patients with risk factors for ischemic strokes. Symptomatic disease includes transient ischemic attacks, stroke in evolution, and complete stroke. Duplex ultrasound scanning is the standard test for the initial evaluation of carotid artery disease. Patients undergoing surgery should also have magnetic resonance angiography or an angiogram of the carotid vessels. Stroke prevention includes lifestyle modification such as cessation of smoking, strict dietary and medical management of hyperlipidemia, diabetes, and hypertension. Antiplatelet, anticoagulant, and thrombolytic therapy can be used where indicated.
authors.affiliation: St. Barnabas Hospital, Bronx, NY, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Eugene
authors.forename: M
authors.initials: M
authors.lastname: Abdallah
authors.forename: M
authors.initials: M
authors.lastname: Miglietta
authors.forename: V V
authors.initials: VV
authors.lastname: Vernenkar
authors.forename: R
authors.initials: R
authors.lastname: Pascual
authors.forename: R
authors.initials: R
authors.lastname: Briones
authors.forename: T
authors.initials: T
authors.lastname: Barnes
authors.forename: J
authors.initials: J
authors.lastname: Hager
mesh_terms: D000368:Aged; D000465:Algorithms; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D011320:Primary Health Care; D011859:Radiography; D012307:Risk Factors; D014463:Ultrasonography