General Practitioners - Carotid Disease

Carotid bifurcation atherosclerosis is a common cause of ischaemic strokes and TIAs. Carotid bruits have poor correlation to carotid stenosis and generally an ultrasound is required to exclude carotid disease. Carotid disease can be separated in to symptomatic and asymptomatic stenosis.

Patients that have TIAs or stroke in the carotid artery circulation should have an ultrasound urgently. Current evidence suggests to get the most benefit from carotid surgery that patient should be operated within 6 weeks, ideally within 2 weeks of symptoms. Symptomatic patients with greater than 50% should be referred for consideration of surgery. Unlike aortic and peripheral artery surgery, the assault from carotid surgery is less and even patient with significant co-morbidities should be considered for intervention if they are symptomatic.

Evidence for asymptomatic carotid stenosis intervention is becoming less strong. Initial studies suggested 5-6% benefit over 5 years. However with better medical management now with statins and antiplatelets, it is reserved with patients with at least 5 year survival and low operative risk.

Carotid stenting was rising in popularity until few years ago when data showed it has a greater stroke risk than surgery. It still useful option in selected patients.