Carotid artery stenosis screening: Clinical sciences

Carotid artery stenosis is defined as the narrowing of one or both of the internal carotid arteries most commonly due to atherosclerotic build-up in the vessels. Because this build-up takes years, the prevalence of carotid artery stenosis increases with age. Patients can be asymptomatic for years before the stenosis becomes so severe that it leads to symptoms and complications. The most significant complication of carotid artery stenosis is ischemic stroke. That is why patients who have carotid artery stenosis need to undergo aggressive medical or surgical therapy in order to prevent the progression of the disease and complications.

Alright, when your patient presents for carotid artery stenosis screening, the initial step will be to assess any risk factors. The big ones would be a personal history of atherosclerotic disease, such as peripheral arterial disease or coronary artery disease. If your patient has any of these risk factors, then they are considered at high risk for developing carotid artery stenosis. Other risk factors also include hypertension, hyperlipidemia, tobacco use, a family history of atherosclerosis diagnosed before age 60, as well as a family history of ischemic stroke. If two or more of these risk factors are present, then your patient is also considered at high risk for developing carotid artery stenosis.

If your patient does not have any of the risk factors mentioned previously, then they are considered to be at low risk for developing carotid artery stenosis, and no routine screening is recommended. One thing to keep in mind is that even though these patients may not need to have any routine screening for carotid artery stenosis, they should still be re-evaluated for any new diagnoses such as hypertension or hyperlipidemia during their regular check-ups with their primary care provider as they might become high-risk over time.

Let’s look at what to do depending on what risk factors are present. (On the other hand,) So, if you determine that the patient is at high risk for carotid artery stenosis, the next step is to order a carotid duplex ultrasound to get a better picture of what’s going on in their carotid arteries.

For patients with stenosis of less than 50% and those with stenosis with 50-69% you should recommend lifestyle changes, as well as medical management of their risk factors. Lifestyle changes include a healthy diet, smoking cessation, weight reduction, and regular exercise. In addition to that, medical management includes treatment with statins, antiplatelet agents like aspirin, management of hypertension, and glycemic control.

Here's the catch! If they have up to 50% stenosis, you can recommend annual screening ultrasound for patients with multiple risk factors. However, if they have stenosis of 50-69%, you must recommend annual screening ultrasound because you need to follow up with these patients and monitor the progression of their stenosis.