AJNN
Academic Journal of Neuropsychiatry and Psychology

Academic Journal of Neuropsychiatry and Psychology (formerly known as the Academic Journal of Neurology and Neurosurgery, e-ISSN:3023-6517), deals with neurology, neurosurgery, psychiatry and clinical psychology accepts articles on these topics. Academic Journal of Neuropsychiatry and Psychology publishes original research articles, review articles, case reports, editorial commentaries, letters to the editor, educational articles, and conference/meeting announcements.

Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Review
Diagnosis and management of carotid artery stenosis: pathophysiology, advanced imaging, and evolving revascularization strategies
Abstract
Carotid artery stenosis is a major and potentially preventable cause of ischemic stroke worldwide. Although the degree of luminal narrowing has traditionally guided risk stratification and treatment decisions, accumulating evidence indicates that plaque composition, biomechanical forces, and hemodynamic factors play a critical role in determining cerebrovascular risk. Atherosclerotic lesions preferentially develop at the carotid bifurcation due to disturbed flow patterns and low wall shear stress, promoting endothelial dysfunction and plaque instability. Recent advances in imaging have shifted diagnostic paradigms beyond luminal assessment toward detailed plaque characterization. Magnetic resonance imaging, particularly with T1-weighted sequences, enables reliable detection of intraplaque hemorrhage and fibrous cap status, both of which are strongly associated with embolic events independent of stenosis severity. These insights have important implications for individualized patient management. Medical therapy remains the cornerstone of treatment for all patients with carotid artery disease. Antiplatelet agents and high-intensity statin therapy play a central role in stroke prevention by reducing thromboembolic risk and promoting plaque stabilization. For patients requiring revascularization, carotid endarterectomy continues to represent the gold standard in appropriately selected symptomatic individuals. Carotid artery stenting has emerged as an alternative for high-risk surgical candidates, although embolic complications associated with transfemoral access remain a concern. Transcarotid artery revascularization, utilizing flow reversal for cerebral protection, has expanded the therapeutic armamentarium and offers a promising hybrid approach with favorable safety profiles. This review provides a comprehensive overview of the epidemiology, pathophysiology, diagnostic advances, and evolving treatment strategies for carotid artery stenosis. Emphasis is placed on multidisciplinary decision-making, patient-specific risk assessment, and the integration of advanced imaging to optimize outcomes in both symptomatic and asymptomatic disease.

Keywords : Carotid artery stenosis, ischemic stroke, atherosclerosis, plaque vulnerability, intraplaque hemorrhage, carotid endarterectomy, carotid artery stenting, transcarotid artery revascularization, flow reversal, advanced imaging

Download Article


1. Matsumoto K, Sera Y, Nakamura H, Ueki Y, Miyake S. Correlation between common carotid arterial wall thickness and ischemic stroke in patients with type 2 diabetes mellitus.Metabolism. 2002;51(2):244-247. doi:10.1053/meta.2002.28971
2. Barnett HJ, Gunton RW, Eliasziw M, et al. Causes and severity of ischemic stroke in patients with internal carotid artery stenosis.Jama. 2000;283(11):1429-1436.
3. Ji X, Leng XY, Dong Y, et al. Modifiable risk factors for carotid atherosclerosis: a meta-analysis and systematic review. Annals Transl Med. 2019;7(22):632.doi:10.21037/atm. 2019.10.115
4. Sakakura K, Nakano M, Otsuka F, Ladich E, Kolodgie FD, Virmani R. Pathophysiology of atherosclerosis plaque progression.Heart, Lung and Circulation. 2013;22(6):399-411. doi:10.1016/j.hlc.2013.03.001
5. Lee SW, Antiga L, Spence JD, Steinman DA. Geometry of the carotid bifurcation predicts its exposure to disturbed flow. Stroke. 2008;39(8): 2341-2347. doi:10.1161/STROKEAHA. 107.510644
6. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379-1387.
7. Rothwell PM, Gibson R, Warlow CP. Current evidence, however, indicates that stroke risk is determined not only by the degree of stenosis but also by the structural and biological characteristics of the atherosclerotic plaque.Stroke. 2000;31(3):615-621. doi:10.1161/01.STR. 31.3.615
8. Wilensky RL, Song HK, Ferrari VA. Role of magnetic resonance and intravascular magnetic resonance in the detection of vulnerable plaques. J Am Coll Cardiol.2006;47(8S):C48-C56. doi:10.1016/j.jacc. 2005.11.048
9. Paciaroni M, Bogousslavsky J. Antithrombotic therapy in carotid artery stenosis: an update.Eur Neurol. 2015;73(1-2):51-56. doi:10.1159/ 000367988
10. Brown MM, Rogers J, Bland JM. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. 2001;357(9270):1729-1737.
11. Almeida SO, Budoff M. Effect of statins on atherosclerotic plaque. Trends Cardiovasc Med. 2019;29(8):451-455. doi:10.1016/j.tcm.2019.01.001
12. Luk Y, Chan YC, Cheng SW. Transcarotid artery revascularization as a new modality of treatment for carotid stenosis.Ann Vasc Surg. 2020;64: 397-404. doi:10.1016/j.avsg.2019.11.001
13. Sardar P, Chatterjee S, Aronow HD, Carotid artery stenting versus endarterectomy for stroke prevention: a meta-analysis of clinical trials.J Am Coll Cardiol. 2017;69(18):2266-2275 doi:10.1016/j.jacc.2017.02.053
14. Tu J, Wang S, Huo Z, Wu R, Yao C, Wang S. Repeated carotid endarterectomy versus carotid artery stenting for patients with carotid restenosis after carotid endarterectomy: systematic review and meta-analysis. Surgery. 2015;157(6):1166-1173. doi:10.1016/j.surg.2015.02.005
15. Esposito G, Amin-Hanjani S, Regli L. Role of and indications for bypass surgery after carotid occlusion surgery study (COSS)?Stroke. 2016; 47(1):282-290. doi:10.1161/STROKEAHA.115. 008220
16. Powers WJ, Clarke WR, Grubb RL Jr, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the Carotid Occlusion Surgery Study randomized trial. JAMA. 2011;306(18):1983-1992. doi:10.1001/jama.2011.1610
17. Megaly M, Alani F, Cheng CI, Ragina N. Risk factors for the development of carotid artery in-stent restenosis: multivariable analysis.Cardiovasc Revasc Med. 2021;24:65-69. doi:10.1016/ j.carrev.2020.09.005
18. Eckstein HH, Kühnl A, Dörfler A, Kopp IB, Lawall H, Ringleb PA. The diagnosis, treatment and follow-up of extracranial carotid stenosis: a multidisciplinary German-Austrian guideline based on evidence and consensus. Deutsches Ärzteblatt International. 2013;110(27-28):468. doi:10.3238/ arztebl.2013.0468
19. White CJ. Carotid artery stenting.J Am Coll Cardiol. 2014;64(7):722-731. doi:10.1016/j.jacc.2014.04.069
20. Patel UK, Malik P, Demasi M, et al. Multidisciplinary approach and outcomes of tele-neurology: a review. Cureus. 2019;11(4):e4410. doi:10. 7759/cureus.4410
Article available in :
Volume 2, Issue 4, 2025
Page : 82-85
https://doi.org/10.51271/AJNN-0038
Article Information
Received : 19 Kas 2025
Accepted : 19 Ara 2025
Published : 31 Ara 2025
Corresponding Author :

Mehmet Kabalcı: Department of Cardiovascular Surgery, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkiye

[email protected]
Citation : Kabalcı M. Diagnosis and management of carotid artery stenosis: pathophysiology, advanced imaging, and evolving revascularization strategies. Acad J Neurol Neurosurg. 2025;2(4):82-85.

Read: 147
Download : 176
Cited: 0
_Footer