The Natural History and Medical Management of Carotid Occlusive Disease

Atherosclerotic disease of the cervical carotid artery is a common source of ischemic stroke, and ever-improving medical and surgical treatments for carotid stenosis decrease stroke incidence. In this chapter we review the pathologic mechanisms and clinical manifestations of atherosclerosis. We then turn our attention to the natural history and medical treatment of both asymptomatic and symptomatic extracranial carotid disease. Optimal treatment includes risk factor modification, pharmacologic therapy, and surgery in some cases. We review the various risk factors for carotid disease, including hypertension, diabetes, dyslipidemia, alcohol consumption, and smoking. After discussing pharmacologic agents that have been used to treat cervical carotid disease, we conclude that low-dose aspirin remains the mainstay of medical treatment. The chapter ends with a brief overview of the impressive evidence for carotid endarterectomy for carotid occlusive disease and its superiority over carotid angioplasty and stenting in most cases.