Extracranial Carotid Artery Disease

This chapter focuses on the ischemic causes of stroke as they relate to extracranial carotid artery occlusive disease, which is responsible for 20% to 30% of strokes. The most common cause of an ischemic stroke is embolism, of which the heart is the major source. Typically, this occurs in the setting of atrial fibrillation (risk: 4% to 7% per year), MI, prosthetic valves, or valvular heart disease. The carotid arteries account for a large portion of embolic strokes’ occurring as a consequence of morphologic change on the luminal surface, mainly in the setting of atherosclerosis. The pathology of carotid disease is divided into two categories: Flowrestrictive lesions and lesions with embolic potential. The most common lesion affecting the extracranial carotid system is atherosclerotic plaque at the carotid bifurcation, which can cause both flow restriction and emboli. After a complete history and physical examination, the carotid arteries are objectively evaluated with a carotid duplex examination.