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. 1991;18(2):93–97.

Extracranial Carotid Artery

Current Concepts of Diagnosis and Management

Jack N Alpert 1
PMCID: PMC324973  PMID: 15227489

Abstract

Extracranial carotid artery disease is a frequent cause of transient ischemic attack (about 50%), but a much less common cause of cerebral infarction (about 15%). Transient ischemic attack almost invariably precedes strokes caused by extracranial carotid stenosis, but rarely heralds strokes that result from cardiogenic embolism or intracranial vascular disease. When extracranial carotid stenosis produces a transient ischemic attack or stroke, artery-to-artery embolism is the predominant mechanism.

Asymptomatic significant (>50%) carotid stenosis poses special clinical questions in patients scheduled to undergo general surgical or major cardiovascular operations. With general surgical procedures, there is no increased risk of stroke. With cardiovascular operations, however, there may be an increased risk of stroke in patients with critical (>90%) carotid stenosis or occlusion. When perioperative stroke occurs, the most common cause is embolism rather than focal hemodynamic change.

For symptomatic high-grade (>70%) extracranial carotid stenosis, carotid endarterectomy is the treatment of choice in patients who are not high-risk surgical candidates. Alternatively, for high-risk patients, new drugs such as ticlopidine appear quite promising, and percutaneous angioplasty may also prove effective.

Prevention of stroke must continue to be a major goal of national medical policy. Because cigarette smoking is the most important risk factor for extracranial carotid disease, more strenuous efforts must be directed toward eliminating this health risk. (Texas Heart Institute Journal 1991;18:93-7)

Keywords: Angioplasty, transluminal

Keywords: arterial occlusive diseases

Keywords: atherosclerosis

Keywords: carotid artery diseases

Keywords: endarterectomy, carotid

Keywords: cerebrovascular disorders

Keywords: embolism

Keywords: stroke

Keywords: transient ischemic attack

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bogousslavsky J., Despland P. A., Regli F. Asymptomatic tight stenosis of the internal carotid artery: long-term prognosis. Neurology. 1986 Jun;36(6):861–863. doi: 10.1212/wnl.36.6.861. [DOI] [PubMed] [Google Scholar]
  2. Bogousslavsky J., Despland P. A., Regli F. Prognosis of high-risk patients with nonoperated symptomatic extracranial carotid tight stenosis. Stroke. 1988 Jan;19(1):108–111. doi: 10.1161/01.str.19.1.108. [DOI] [PubMed] [Google Scholar]
  3. Bogousslavsky J., Hachinski V. C., Boughner D. R., Fox A. J., Viñuela F., Barnett H. J. Cardiac and arterial lesions in carotid transient ischemic attacks. Arch Neurol. 1986 Mar;43(3):223–228. doi: 10.1001/archneur.1986.00520030015005. [DOI] [PubMed] [Google Scholar]
  4. Caplan L. R., Sergay S. Positional cerebral ischaemia. J Neurol Neurosurg Psychiatry. 1976 Apr;39(4):385–391. doi: 10.1136/jnnp.39.4.385. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chimowitz M. I., Furlan A. J., Nayak S., Sila C. A. Mechanism of stroke in patients taking aspirin. Neurology. 1990 Nov;40(11):1682–1685. doi: 10.1212/wnl.40.11.1682. [DOI] [PubMed] [Google Scholar]
  6. Crouse J. R., Toole J. F., McKinney W. M., Dignan M. B., Howard G., Kahl F. R., McMahan M. R., Harpold G. H. Risk factors for extracranial carotid artery atherosclerosis. Stroke. 1987 Nov-Dec;18(6):990–996. doi: 10.1161/01.str.18.6.990. [DOI] [PubMed] [Google Scholar]
  7. DeMonte F., Peerless S. J., Rankin R. N. Carotid transluminal angioplasty with evidence of distal embolization. Case report. J Neurosurg. 1989 Jan;70(1):138–141. doi: 10.3171/jns.1989.70.1.0138. [DOI] [PubMed] [Google Scholar]
  8. FISHER M. Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatry. 1951 Mar;65(3):346–377. doi: 10.1001/archneurpsyc.1951.02320030083009. [DOI] [PubMed] [Google Scholar]
  9. Fode N. C., Sundt T. M., Jr, Robertson J. T., Peerless S. J., Shields C. B. Multicenter retrospective review of results and complications of carotid endarterectomy in 1981. Stroke. 1986 May-Jun;17(3):370–376. doi: 10.1161/01.str.17.3.370. [DOI] [PubMed] [Google Scholar]
  10. Freitag G., Freitag J., Koch R. D., Wagemann W. Percutaneous angioplasty of carotid artery stenoses. Neuroradiology. 1986;28(2):126–127. doi: 10.1007/BF00327883. [DOI] [PubMed] [Google Scholar]
  11. Furlan A. J., Craciun A. R. Risk of stroke during coronary artery bypass graft surgery in patients with internal carotid artery disease documented by angiography. Stroke. 1985 Sep-Oct;16(5):797–799. doi: 10.1161/01.str.16.5.797. [DOI] [PubMed] [Google Scholar]
  12. Gomez C. R. Carotid plaque morphology and risk for stroke. Stroke. 1990 Jan;21(1):148–151. doi: 10.1161/01.str.21.1.148. [DOI] [PubMed] [Google Scholar]
  13. González-Scarano F., Hurtig H. I. Neurologic complications of coronary artery bypass grafting: case-control study. Neurology. 1981 Aug;31(8):1032–1035. doi: 10.1212/wnl.31.8.1032. [DOI] [PubMed] [Google Scholar]
  14. Grotta J. C. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. 1987 Dec 10;317(24):1505–1516. doi: 10.1056/NEJM198712103172405. [DOI] [PubMed] [Google Scholar]
  15. Harrison M. J., Marshall J. Arteriographic comparison of amaurosis fugax and hemispheric transient ischaemic attacks. Stroke. 1985 Sep-Oct;16(5):795–797. doi: 10.1161/01.str.16.5.795. [DOI] [PubMed] [Google Scholar]
  16. Hart R., Hindman B. Mechanisms of perioperative cerebral infarction. Stroke. 1982 Nov-Dec;13(6):766–773. doi: 10.1161/01.str.13.6.766. [DOI] [PubMed] [Google Scholar]
  17. Hass W. K., Easton J. D., Adams H. P., Jr, Pryse-Phillips W., Molony B. A., Anderson S., Kamm B. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. Ticlopidine Aspirin Stroke Study Group. N Engl J Med. 1989 Aug 24;321(8):501–507. doi: 10.1056/NEJM198908243210804. [DOI] [PubMed] [Google Scholar]
  18. Hennerici M., Hülsbömer H. B., Hefter H., Lammerts D., Rautenberg W. Natural history of asymptomatic extracranial arterial disease. Results of a long-term prospective study. Brain. 1987 Jun;110(Pt 3):777–791. doi: 10.1093/brain/110.3.777. [DOI] [PubMed] [Google Scholar]
  19. Humphries A. W., Young J. R., Santilli P. H., Beven E. G., deWolfe V. G. Unoperated, asymptomatic significant internal carotid artery stenosis: a review of 182 instances. Surgery. 1976 Dec;80(6):695–698. [PubMed] [Google Scholar]
  20. Pessin M. S., Duncan G. W., Mohr J. P., Poskanzer D. C. Clinical and angiographic features of carotid transient ischemic attacks. N Engl J Med. 1977 Feb 17;296(7):358–362. doi: 10.1056/NEJM197702172960703. [DOI] [PubMed] [Google Scholar]
  21. Pokras R., Dyken M. L. Dramatic changes in the performance of endarterectomy for diseases of the extracranial arteries of the head. Stroke. 1988 Oct;19(10):1289–1290. doi: 10.1161/01.str.19.10.1289. [DOI] [PubMed] [Google Scholar]
  22. RUSSELL R. W. Observations on the retinal blood-vessels in monocular blindness. Lancet. 1961 Dec 30;2(7218):1422–1428. doi: 10.1016/s0140-6736(61)91247-8. [DOI] [PubMed] [Google Scholar]
  23. Sacco R. L., Ellenberg J. H., Mohr J. P., Tatemichi T. K., Hier D. B., Price T. R., Wolf P. A. Infarcts of undetermined cause: the NINCDS Stroke Data Bank. Ann Neurol. 1989 Apr;25(4):382–390. doi: 10.1002/ana.410250410. [DOI] [PubMed] [Google Scholar]
  24. Toole J. F., Janeway R., Choi K., Cordell R., Davis C., Johnston F., Miller H. S. Transient ischemic attacks due to atherosclerosis. A prospective study of 160 patients. Arch Neurol. 1975 Jan;32(1):5–12. doi: 10.1001/archneur.1975.00490430027003. [DOI] [PubMed] [Google Scholar]
  25. Towne J. B., Weiss D. G., Hobson R. W., 2nd First phase report of cooperative Veterans Administration asymptomatic carotid stenosis study--operative morbidity and mortality. J Vasc Surg. 1990 Feb;11(2):252–259. [PubMed] [Google Scholar]
  26. Whisnant J. P., Homer D., Ingall T. J., Baker H. L., Jr, O'Fallon W. M., Wievers D. O. Duration of cigarette smoking is the strongest predictor of severe extracranial carotid artery atherosclerosis. Stroke. 1990 May;21(5):707–714. doi: 10.1161/01.str.21.5.707. [DOI] [PubMed] [Google Scholar]
  27. Winslow C. M., Solomon D. H., Chassin M. R., Kosecoff J., Merrick N. J., Brook R. H. The appropriateness of carotid endarterectomy. N Engl J Med. 1988 Mar 24;318(12):721–727. doi: 10.1056/NEJM198803243181201. [DOI] [PubMed] [Google Scholar]

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