Carotid Artery Stenosis
Atherosclerotic carotid stenosis can embolise to the retina or ipsilateral cerebral circulation; recent carotid-territory TIA or non-disabling stroke makes the lesion time-critical, with urgent imaging, best medical treatment and selected carotid endarterectomy.
Definition
Carotid artery stenosis is narrowing of an extracranial carotid artery, usually from atherosclerosis. It may be asymptomatic or cause retinal or cerebral ischaemia through plaque embolisation.
First principles
Most events are plaque embolisation, not simple low flow
Atherosclerotic plaque at the carotid bifurcation can ulcerate or carry superimposed thrombus, allowing platelet-rich or cholesterol-containing material to embolise into the ophthalmic or cerebral circulation. Collateral flow often protects the brain from isolated flow reduction, although haemodynamic compromise can contribute in critical disease with poor collaterals or contralateral occlusion.
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