AIS Carotid Stenosis

Posted On August 22, 2021

Symptomatic Internal carotid artery stenosis

Risk of stroke
- Cause of 10% of all ischemic stroke
- A Transient Ischemic Attack is associated with higher risk of stroke
- Risk is related to
  - age, sex, degree of stenosis, presenting symptom, time since last event, smooth vs irregular plaque
  - Carotid stenosis tool to calculate risk
Medical Treatment
- For acute ischemic stroke, go to AIS Management
- Transient Ischemic Attack, Minor ischemic stroke:
  - Double antiplatelet treatment (DAPT) ASA 325 mg, Clopidogrel 300 mg loading, followed by ASA 325 mg qd and Clopidogrel 75 mg qd x 21 days, then ASA alone.
- Above with intracranial large artery stenosis: DAPT for 90 days
- Large severe stroke: start aspirin monotherapy. Start DAPT after 7 days.
Carotid endarterectomy: (CEA)
- continue aspirin before and after procedure
- After Minor stroke: perform 1-2 weeks after a nondisabling stroke
- After moderate to severe stroke: perform 2 to 4 weeks after last event.
Carotid artery stenting: (CAS)
- DAPT before procedure and continue DAPT at least 30 days after procedure
Indications for revascularization: CEA or CAS
- Stenosis 70-99%
- Life expentacy > 5 years
- NO significant disease that will greatly increase risk of anesthesia and surgery

Intensive medical therapy
For medically stable patients:
- 70-99% stenosis: revascularization is reasonable

Notes