Carotid artery stenosis: principles and interventional treatment possibilities

Tomas Tvarijonas1, Mindaugas Stonis1, Emilija Šabatina1

1Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

Abstract: Most commonly carotid artery stenosis (MAS) is asymptomatic. When the MAS is severe, there is a possibility of cerebral ischemia. Studies show that 2-5% of patients experience an ischemic stroke every year. Therefore, patients with risk factors should be screened for MAS. Ultrasound Doppler examination is used for initial diagnosis. If necessary, more complex radiological examinations are performed, of which the interventional procedure – carotid artery angiography is considered the gold standard. Even after the initial detection of MAS during the ultrasound examination, antiplatelet agents and lipid-lowering drugs should be prescribed, hypertension should be corrected, and a healthy lifestyle should be followed. Invasive therapies are indicated when stenosis is 50-99 % for patients with symptoms or 60 – 99 % for asymptomatic patients. Endarterectomy is considered the first-line treatment. The possibility of stenting is suggested for patients at moderate to high risk of complications from open surgery. Interventional radiology has greatly improved over the last few decades. Distal, later proximal occlusion and other techniques have emerged to protect patients from a possible periprocedural stroke during stenting. Monitoring the rapid progress of stenting techniques requires new studies assessing the differences between minimally-invasive and surgical treatments.

Keywords: carotid artery stenosis, interventional radiology, medical therapy.