Treatment strategies for extracranial carotid stenosis

Atherosclerotic lesions of the extracranial carotid artery represent the source for ischemic stroke in about 25% of cases. Diagnosis is based on ultrasound scanning rather than angiography. Endarterectomy with a patchplasty and eversion endarterectomy are two equivalent surgical techniques depending on the morphology of the stenosis. Carotid angioplasty and stenting are currently under evaluation in multicenter studies. For symptomatic stenoses there is clear evidence that endarterectomy reduces the risk for an ischemic re-stroke compared with medical treatment. Operative treatment of asymptomatic stenoses should only be performed when the perioperative risk does not exceed 3%. Medical treatment should include statins and ACE inhibitors in addition to platelet inhibitors.