Head and Neck: Quantification of Carotid Stenosis- Page 1

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Thrombotic and embolic events due to carotid arteriosclerotic disease are a major cause of cerebral infarction. Carotid endarterectomy has been shown to decrease the risk of stroke. However, both the surgical procedure and the preoperative diagnostic test pose potential risks. These risks determine the degree of stenosis at which surgical intervention is superior to medical management. Current management of carotid arteriosclerotic disease is based on the results of the North American Symptomatic Carotid endarterectomy Trial (NASCET) which showed that carotid endarterectomy has a clear benefit in symptomatic patients with carotid stenosis of 70% or greater as determined by conventional angiography. This "cut-point" is based on the current risks of surgical management, which include up to a 1.5% risk of major morbidity and mortality associated with conventional angiography. Recent studies suggest that the risk associated with conventional angiogaphy is equal to or greater than that of the surgical procedure itself. This significant risk, coupled with the expense of angiography, have led to a recent shift in the surgical community toward basing the decision of whether or not to operate on noninvasive imaging modalities including ultrasound, MR angiography, and recently, CT angiography.