Management of Diseases Caught by a Carotid Ultrasound
Medical Management in Asymptomatic Carotid Disease
Because the risk of stroke with carotid narrowing (~50%) is very low in patients who have had no signs or symptoms of cerebral ischemia or TIAs, medical management is used to control the risk factors and mitigate disease progression:
blood pressure control, lifestyle alterations, statin therapy for cholesterol abnormalities, smoking cessation, weight control, aerobic exercise, and dietary modifications. For those who progress to >80% stenosis or who have or develop symptoms, invasive surgical measures are indicated.
Surgical Management of Progressive or Symptomatic Carotid Disease
Reestablishing carotid blood flow–revascularization–is indicated for any symptomatic disease (TIAs, monocular blindness, or stroke) and also for asymptomatic disease for which medical management has failed to halt progression.
- Carotid Endarterectomy (CEA): Because of the lower risk of stroke or death, carotid endarterectomy has emerged as the treatment of choice.
- Carotid Artery Stenting(CAS): Placing a patent tube into the artery. This is recommended if the carotid artery is not surgically accessible, if there has been radiation-caused stenosis, or if the patient is not cardiac-stable for surgery.
The choice between CEA and CAS is more complicated than this and relies on other intangible factors such as surgeon experience, patient preference, likely compliance with follow-up, etc. As such, it is individualized in a risk-vs-benefit formula that involves both physician preference and patient health status.