Management depends on
2. Degree of carotid artery narrowing and progression over time
3.Type of carotid plaque
4. Additional blockage of one or several arteries supplying the brain
5. Overall patient risk profile.
Patients who are ASYMPTOMATIC, who are found 50% blockage of the neck internal carotid artery by ultrasound or CT should be treated conservatively by BP and diabetes control, smoking cessation, antiplatelet and statin therapy. Such patients should be followed closely every 3-6 months for symptoms and for evaluation of the blockage by duplex ultrasound.
In select ASYMPTOMATIC patients intervention by stenting or surgery may be necessary. These include patients with more than 70% who are low risk for intervention, if there rapid progression of the blockage by serial ultrasound or if there is evidence of a soft plaque or clot which may produce a future stroke.
In SYMPTOMATIC patients with more than 50% blockage of the cervical internal carotid artery who have suffered a reversible or a fixed non disabling stroke or related eye symptoms MUST consider correction of the blockage by surgery or stenting.