Among patients that suffer a stroke, extracranial carotid artery disease represents the cause of approximately one half of cases. Hypertension, coronary artery disease, peripheral arterial stenosis, obesity and diabetes are associated with an increased incidence of carotid artery stenosis. Patients with significant carotid artery stenosis are at an increased risk for stroke, myocardial infarction (heart attack) and death.
If the degree of carotid artery stenosis is severe and there is no compensatory collateral circulation, a portion of the brain becomes underperfused. A diminution of cerebral blood flow increases the risk of thrombosis within the cerebral circulation. Localized thrombosis may also occur in areas with pre- existing atherosclerotic disease. Assessment of a patient who presents with cerebral vascular disease should include evaluation of the patency of the carotid arteries.
Carotid artery stenosis can be symptomatic or asymptomatic. In asymptomatic patients, detection of a carotid bruit on physical examination requires further assessment to rule out carotid artery stenosis. The increased risk of stroke is greater in patients with symptomatic carotid artery stenosis but asymptomatic carotid artery stenosis is also associated with an increased risk for stroke. In some patients with hypertension and asymptomatic carotid artery stenosis, attempts at lowering the blood pressure may trigger the appearance of cerebral ischemic symptoms such as a transient ischemic attack (TIA).
Detecting carotid artery stenosis early and the use of surgery or endovascular treatment can prevent a stroke from happening. Detection of carotid artery stenosis include:
Transcranial Doppler Ultrasonography
CT angiography (CTA)
Magnetic resonance angiography (MRA)
Doppler ultrasonography is the primary noninvasive test for evaluation of carotid artery stenosis. Measurement of the Peak Systolic Velocity, Peak End Diastolic Velocity and Peak Systolic velocity ration show good correlation with the degree of carotid artery stenosis.
Mild to moderate carotid artery stenosis is amenable to medical treatment of the underlying condition and the administration of oral medication. Reducing the progression of the atherosclerotic disease and controlling hypertension reduces the likelihood of progression to a more severe degree of arterial stenosis. The administration of aspirin decreases the chances of platelet or small clot formation with subsequent embolization. Severe carotid artery stenosis greater than 70% may require carotid endarterectomy or stenting to bypass the area of stenosis.
If you are suffering from complications due to a delayed diagnosis or failure to treat a carotid artery stenosis that caused you a stroke or the mismanagement of a stroke, let Dr. Borten review the specifics of your case. At Gorovitz & Borten we have the necessary experience, understanding and resources available to properly evaluate the complications of a stroke, and give you a timely assessment of its merits.
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