Management of transient ischemic attack or nondisabling stroke related to extracranial internal carotid artery stenosis

• Published in: Canadian Medical Association journal (CMAJ) Vol. 191; no. 15; pp. E418 - E422
• Main Authors: Kapila, Varun, Jetty, Prasad, Basile, Vincenzo S., Dubois, Luc
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Inc 15.04.2019; CMA Impact, Inc; Joule Inc
• Subjects: Amino Acids - therapeutic use; Carotid arteries; Carotid Arteries - pathology; Carotid Stenosis - complications; Carotid Stenosis - surgery; Collaboration; Disease management; Disease prevention; Endarterectomy, Carotid; Humans; Internal Medicine; Intervention; Ischemia; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - prevention & control; Platelet Aggregation Inhibitors - therapeutic use; Randomized Controlled Trials as Topic; Review; Stroke; Stroke - etiology; Stroke - prevention & control; Surgery; Systematic review; Transient ischemic attack; Veins & arteries
• ISSN: 0820-3946; 1488-2329; 1488-2329
• DOI: 10.1503/cmaj.180735

Cerebrovascular disease is not only the third largest cause of death in Canada, it is also associated with substantial functional morbidity after an event. In 2013, over 400 000 Canadians were living with the disabling effects of a stroke, most of which were due to ischemic injury. Symptoms usually occur because of atherosclerotic plaque rupture in the internal carotid artery and embolization of plaque particles to the brain, which leads to transient or persistent ischemia in a specific anatomic area and related neurologic symptoms. Population-based studies have suggested a high risk of recurrent transient ischemic attack or stroke after an index event from a moderate to severe stenosis of the extracranial internal carotid artery, ranging from 10% to 20% within the next 90 days. Here, Kapila et al review the medical and surgical management of patients with symptomatic extracranial internal carotid artery stenosis, focusing on recent guidelines, large trials and meta-analyses, and highlighting recent evidence supporting early carotid intervention.