The prevalence of CAS is slightly higher in men than women.4, Hypertension is a strong risk factor for CAS. Carotid artery stenosis: accuracy of noninvasive tests--individual patient data meta-analysis. A left MCA stroke may cause expressive aphasia. In addition to containing the, Vertebral artery ostial stenosis has been treated medically and intervention has been indicated only in selected patients. Halliday A, Mansfield A, Marro J, et al; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Chambless LE, Folsom AR, Davis V, et al. From Grant E G, Benson C B, Moneta G L, et al. Atherosclerotic carotid disease occurs when lipoprotein accumulates in the intima of the artery and is oxidatively modified. Note the smooth echogenic intimal surface. Cosottini M, Pingitore A, Puglioli M, et al. Again, best medical therapy at the time was aspirin. The SVS guidelines recommend that all patients with CAS be treated for hypertension and hypercholesterolemia and offered smoking cessation therapies, along with antiplatelet therapy.48. A right MCA stroke may cause unilateral neglect. CTA or MRA are options when DUS is not readily available or when results are equivocal.47 The Society for Vascular Surgery (SVS) guidelines, also issued in 2011, recommend against screening of asymptomatic patients with carotid bruit and no other risk factors for atherosclerosis.48 The U.S. Preventive Services Task Force recommends against screening for CAS in asymptomatic persons.48, Control of hypertension is critical in preventing stroke.49,50 Although it is clear that uncontrolled hypertension is associated with the development of carotid atherosclerosis, it is less clear whether treatment of hypertension prevents progression of carotid lesions. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Nevertheless, hypercholesterolemia was associated with CAS in the Framingham Heart Study and with carotid atherosclerosis as reflected by carotid intima-media thickness (IMT) in several other studies.6,10-12, Diabetes is associated both with carotid IMT and CAS and their progression.13-18 About 1% of asymptomatic persons 65 years of age and older are estimated to have CAS of 60% to 99%.19 In one study, 7% of all first ischemic strokes occurred in patients with CAS of greater than 60%.20, Studies suggest that 5% of individuals with CAS of 70% or more will have a stroke within 5 years9 and quality, long-term data beyond 5 years are lacking. Utter GH, Hollingworth W, Hallam DK, Jarvik JG, Jurkovich GJ. Sillesen H, Amarenco P, Hennerici MG, et al; Stroke Prevention by Aggressive Reduction in Cholesterol Levels Investigators. Complication rate and control of risk factors. NASA, Web. The type of symptoms depends on where the thromboembolism occurs. Singh S, Loke YK, Spangler JG, Furberg CD. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Patients with established CAS should be asked about smoking status at every visit and current smokers should be offered smoking cessation interventions. The SVS recommends medical management only for symptomatic patients with stenosis less than 50% and asymptomatic patients with stenosis less than 60%. The AHA encourages practitioners to consider individual patient factors including life expectancy in determining which asymptomatic patients should be revascularized. Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Race-ethnicity and determinants of carotid atherosclerosis in a multiethnic population. Ultrasound assessment of carotid arterial atherosclerotic disease has become the first choice for carotid artery stenosis screening, permitting the evaluation of both the macroscopic appearance of plaques as well as flow characteristics in the carotid artery.. Please look for them carefully.

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