Carotid artery stenosis: diagnosis and guidelines for management

In carotid artery stenosis, the carotid arteries become blocked by fatty cholesterol deposits. Older individuals with high cardiovascular risk are disproportionately susceptible to this condition, for which risk factors include smoking, high cholesterol, male sex, and older age. When the vascular endothelium is damaged by the above-mentioned causes, low-density lipoproteins invade the inside of the endothelium and undergo an oxidation process. Monocytes infiltrate the endothelium in response to oxidized low-density lipoproteins and transform into lipid-laden macrophages, thereby activating inflammatory responses. As this inflammatory reaction progresses further, various decomposing enzymes are secreted, causing the atherosclerotic plaque to rupture and various thrombogenic materials to be secreted into the blood, resulting in the formation of blood clots and vascular stenosis or occlusion. This can cause symptoms ranging from mild, such as blurred-vision, to severe, such as life-threatening stroke. Carotid artery stenosis accounts for approximately 10% of all strokes. Therefore, early diagnosis and appropriate management are very important. When choosing between medical and surgical treatment, it is necessary to consider various factors, such as patient characteristics, symptoms, risk factors, and imaging results. In this review, we discuss the pathophysiology of carotid artery stenosis, risk factors, and the importance of prompt diagnosis and treatment. In particular, we focus on how to determine the need for treatment and select management methods for each individual patient.