Asymptomatic carotid stenosis: screening and management.

the management of asymptomatic carotid stenosis can be a dilemma to the primary care physician. In this review, we hope to update the reader on current insights into asymptomatic carotid atherosclerosis. Carotid stenosis is defined as the atherosclerotic narrowing of the proximal internal carotid artery exceeding 70% in severe cases and 50% in moderate cases. The prevalence of carotid stenosis in Western countries increases with age. A recent Western European population study placed the prevalence of moderate asymptomatic stenosis at 4.2% and severe stenosis at 1.7%. The prevalence was found to increase with age and be higher in males, with 12.5% of men being diagnosed with moderate stenosis. Fisher first described the pathophysiology of carotid atherosclerosis in 1951. Since then it has increasingly been recognized as a risk factor and cause of stroke. A population based study of subjects older than 55 found that the presence of a severe carotid plaque burden increased the relative risk of a non-lacunar infarction in the anterior circulation by 3.2 times and increased the risk of a lacunar infarction by 10.8 times. Accordingly, asymptomatic carotid stenosis has become an important cerebrovascular topic for the primary care physician.