Managing atherosclerotic carotid disease: treatment essentials

Atherosclerotic carotid disease (ACD) is a common etiology of stroke, demanding a comprehensive understanding of effective intervention.This review explores the pathophysiology and treatment strategies for ACD, as well as the diagnostic imaging findings.ACDs can cause ischemic strokes by different mechanisms including plaque rupture, embolism, and stenosis-induced hypoperfusion.Early intervention is vital to avert adverse outcomes.Medical management remains the first line of treatment in the form of antiplatelets, antihypertensives, and statins.While carotid artery stenting (CAS) has gained traction in the last few years, carotid endarterectomy (CEA) remains favored for asymptomatic cases in international guidelines.Current evidence has revealed that both CAS and CEA are reasonable options for symptomatic cases.Doppler ultrasound, computed tomography angiography, and magnetic resonance imaging are pivotal in diagnosing and characterizing ACD plaques.Plaque features, such as lipid-rich necrotic core, fibrous cap thickness, or intraplaque hemorrhage are essential in guiding the treatment.