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Management of carotid atherosclerosis in stroke
  1. Nicholas Richard Evans1,
  2. Shiv Bhakta1,
  3. Mohammed M Chowdhury2,
  4. Hugh Markus1,
  5. Elizabeth Warburton1
  1. 1Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  2. 2Department of Vascular Surgery, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Nicholas Richard Evans, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; ne214{at}


Internal carotid artery atherosclerosis is a major risk factor for stroke, accounting for 15–20% of ischaemic strokes. Revascularisation procedures—either carotid endarterectomy or carotid artery stenting—can reduce the risk of stroke for those with significant (>50%) luminal stenosis but particularly for those with more severe (70–99%) stenosis. However, advances in medical pharmacotherapy have implications for the relative benefit from surgery for symptomatic carotid atherosclerosis, as well as our approach to asymptomatic disease. This review considers the evidence underpinning the current medical and surgical management of symptomatic carotid atherosclerosis, the importance of factors beyond the degree of luminal stenosis, and developments in therapeutic strategies. We also discuss the importance of non-stenotic but high-risk carotid atherosclerotic plaques on the cause of stroke, and their implications for clinical practice.


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  • X @nr_evans

  • Contributors NRE conceived the review and wrote the first draft. SB, MMC, HM and EW contributed intellectual content and revised subsequent drafts.

  • Funding NRE is supported by a Stroke Association Senior Clinical Lectureship (SA-SCL-MED-22/100006) and by the NIHR Cambridge Biomedical Research Centre (NIHR203312). SB is supported by a Research Training Fellowship from the Dunhill Medical Trust (JBGS22/20). MMC is supported by an Academic Clinical Lectureship from the NIHR and a Clinical Career Development Fellowship from the British Heart Foundation.

  • Competing interests None declared.

  • Provenance and peer review Commissioned. Externally peer reviewed by Anthony Pereira, London, UK.

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