[Diagnosis and treatment of symptomatic and asymptomatic carotid disease].

OBJECTIVE

Provide a management strategy for the evaluation and treatment of extracranial internal carotid artery disease.

BACKGROUND

Despite 50 years that have elapsed since the first carotid artery endarterectomy, surgical indications in symptomatic and asymptomatic carotid artery disease remain controversial.

DESIGN

The most important studies on the treatment of symptomatic and asymptomatic internal carotid artery disease were reviewed. Special scenarios were analyzed including: intraluminal thrombus, carotid artery occlusion, dissection, ulceration, fibromuscular dysplasia, re-stenosis post endarterectomy and carotid artery disease coexisting with coronary artery disease. The current status of carotid angioplasty was discussed briefly.

CONCLUSIONS

A patient-individualized approach based on the aforementioned studies and personal experience is provided. Endarterectomy is recommended in greater than 70% ICA symptomatic stenosis, in certain patients with 50 to 69% symptomatic stenosis, and exceptionally in asymptomatic patients, patients with associated coronary artery disease, ulceration, intraluminal thrombus and other less frequent scenarios.