Imaging of Carotid Artery Stenosis

Imaging of Carotid Artery Stenosis, 9783211323328 (3211323325), Springer, 2007

An adequate and state-of-the-art treatment of atherosclerotic disease of the extra- and intracranial carotid arteries in a patient with an advanced degree of stenosis substantially reduces the risk of subsequent ischemic stroke in patients with recently symptomatic 70 to 99% carotid artery stenosis. The benefit that is to be expected for 50 to 69% symptomatic stenosis, and for asymptomatic stenosis, is more modest [3].Whether surgical endarterectomy, endovascular stent placement or any other treatment option proves to be the more effective treatment strategy of the narrowed carotid artery has not yet to be demonstrated. In any event, accurate assessment of the degree of luminal narrowing is an important step in the treatment planning. Conventional angiography was generally used to select patients for treatment in the past. However, given the risks of death and disabling stroke due to angiography (1.2% in the Asymptomatic Carotid Atherosclerosis Study [9] versus 1.1% for surgery itself), alternative noninvasive imaging techniques have been sought and investigated during the last years. There are several reasons for such a procedure: (i) the noninvasive methods are safe compared with conventional angiography, which still carries a mortality/morbidity rate of 1.2%, (ii) the noninvasive imaging can be done on an outpatient basis and is clearly preferred by patients and (iii) many physicians believe now that noninvasive imaging is sufficiently sensitive and specific to be used in at least some situations before endarterectomy.

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