Carotid Stenosis

• Carotid endarterectomy for appropriate patients should be carried out within two weeks of symptom onset and if at all possible within 48 hours of symptoms onset.
• Carotid endarterectomy should be considered for all patients with a carotid stenosis of >50-99%.
• Patients who meet the criteria for a carotid endarterectomy should be referred to vascular surgeon as per carotid endarterectomy pathway.
• Urgent carotid CTA or MRA should be arranged at the time of referral to reduce delays.
• As carotid surgery is usually possible under local anaesthesia there should be few patients excluded on the basis of poor cardio-respiratory fitness.
• Patients with a major persisting neurological deficit and/or with a large infarct visible on CT scanning are probably not suitable for carotid surgery.
• Most patients with a carotid stenosis should be treated with an antiplatelet agent and a statin. The decision on the use and duration of antiplatelets or anticoagulants prior to surgery should be discussed with the vascular surgeon and refer to the perioperative management of patient on oral anticoagulants/antiplatelet agents guideline on AthenA.
• Hypertension should be controlled prior to carotid surgery or angioplasty/stenting.