title: Diagnosis of and treatment for symptomatic carotid stenosis: an updated review.
abstract: Carotid stenoses of ≥50% account for about 15-20% of strokes. Their degree may be moderate (50-69%) or severe (70-99%). Current diagnostic methods include ultrasound, MR- or CT-angiography. Stenosis severity, irregular plaque surface, and presence of microembolic signals detected by transcranial Doppler predict the early recurrence risk, which may be as high as 20%. Initial therapy comprises antiplatelets and statins. Benefit of revascularization is greater in men, in older patients, and in severe stenosis; patients with moderate stenoses may also profit particularly if the plaque has an irregular aspect. An intervention should be performed within <2 weeks. In large randomized studies comparing endarterectomy and stenting, endovascular therapy was associated with a higher risk of periprocedural stroke, yet in some studies, with a lower risk of myocardial infarction and of cranial neuropathy. These trials support endarterectomy as the first choice treatment. Risk factors for each of the two therapies have been indentified: coronary artery disease, neck radiation, contralateral laryngeal nerve palsy for endarterectomy, and, elderly patients (>70 years), arch vessel tortuosity and plaques with low echogenicity on ultrasound for carotid stenting. Lastly, in direct comparisons, a contralateral occlusion increases the risk of periprocedural complications in both types of treatment.
authors.affiliation: Neurology Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
authors.forename: I
authors.initials: I
authors.lastname: Momjian-Mayor
authors.forename: P
authors.initials: P
authors.lastname: Burkhard
authors.forename: N
authors.initials: N
authors.lastname: Murith
authors.forename: D
authors.initials: D
authors.lastname: Mugnai
authors.forename: H
authors.initials: H
authors.lastname: Yilmaz
authors.forename: A-P
authors.initials: AP
authors.lastname: Narata
authors.forename: K
authors.initials: K
authors.lastname: Lovblad
authors.forename: V
authors.initials: V
authors.lastname: Pereira
authors.forename: M
authors.initials: M
authors.lastname: Righini
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.forename: R F
authors.initials: RF
authors.lastname: Sztajzel
mesh_terms: D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D020521:Stroke / Q000209:etiology