Carotisstenose – utredning og behandling

Abstract

About 12,000 people suffer an ischemic stroke in Norway every year; 20 % of them may be caused by emboli from precerebral arteries. We discuss the epidemiology of carotid artery stenoses and assessment upon suspicion, and provide an overview of medical treatment and indications for surgery. The article is based on literature identified through non-systematic searches in PubMed, core medical journals and textbooks and the authors' experience from a vascular surgical department and stroke unit. Stroke symptoms or recurrent transient ischemic attacks (TIAs) should lead to direct admission to hospital, while patients with single TIAs should be assessed as out-patients in a hospital within a few days. Risk-factors should be investigated, and the carotid arteries should be examined with duplex ultrasound upon suspicion of stenosis. There is only a weak correlation between a neck bruit and an ipsilateral carotid artery stenosis, but a connection can usually be clarified by use of duplex ultrasound. All patients with a carotid artery stenosis should have medical treatment to prevent complications of atherosclerotic disease; i.e. antithrombotic, and for the majority cholesterol-lowering treatment and possibly antihypertensive medication. Patients with a symptomatic carotid artery stenosis of more than 50 % diameter reduction should be considered for surgical treatment within 14 days. Surgery for asymptomatic carotid artery stenoses seems to have a marginal effect. Patients with stroke-like symptoms should be examined by a doctor as soon as possible. Quick diagnosis and treatment of patients with cerebrovascular events is demanding for the logistics of our hospitals.