Treatment is based upon the degree of stenosis present, and whether the patient is symptomatic (i.e. whether the patient has had a recent TIA or stroke as a result of their carotid disease). Degree of stenosis is detected on duplex ultrasound scanning. All patients with documented carotid stenosis should commence conservative and medical management. This should include dietary modifications, smoking cessation, antiplatelet therapy and a statin.
Patients with <50% stenosis are unlikely to require surgical intervention.
Patients with a stenosis of 50-69% should be considered for surgical intervention if they have had a recent TIA / stroke despite already being on best medical therapy (i.e. antiplatelet medication and a statin).
Patients with a >70% stenosis who experience a recent TIA / stroke as a result of their carotid stenosis should be considered for surgical intervention. This most commonly takes the form of a carotid endarterectomy.
All patients for carotid artery intervention are discussed in our neurovascular multi-disciplinary meeting attended by stroke physicians, vascular surgeons, neurovascular interventional radiologists and the vascular lab staff.