Non-stenotic Carotid Disease: Review of the Literature and Case Discussion of TCAR for Treatment

Abstract: Non-stenotic carotid disease represents an understudied yet clinically significant pathology. While stenosis is the primary mechanism underlying most strokes, other mechanisms such as thromboembolism from plaque rupture and carotid webs have been implicated in symptomatic non-stenotic carotid disease (SyNC). Studies have identified imaging features of high-risk non-stenotic plaques, but there is currently no standardized definition or imaging protocol for SyNC. Furthermore, despite current guidelines not recommending surgical intervention, an emerging body of literature suggests that carotid endarterectomy and carotid artery stenting may be safe and effective treatments for SyNC. In this review, we provide an overview of the existing knowledge on SyNC, including a recently proposed working definition, the underlying pathophysiology, characteristics of vulnerable plaques, and current management strategies. Additionally, we present a case from our institution using transcarotid artery revascularization (TCAR) to treat SyNC, which, to our knowledge, is the first such report in the literature.