Carotid Disease

Cerebrovascular accident, more commonly known as stroke, may be defined as a rapidly developing episode of focal loss of cerebral function

Cerebrovascular accident (CVA), more commonly known as stroke may be defined as a rapidly developing episode of focal loss of cerebral function, lasting more than 24 hours and of presumed vascular origin (18). There are 5 to 10 million deaths from stroke/year worldwide, making it the 3rd commonest cause of death, responsible for 7% of deaths in the Western World (19). As a result, the affected area of the brain cannot function, which might result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field (18). Risk factors for stroke can be classified as either ‘modifiable’ or ‘fixed’(18). Some modifiable factors such as hypertension, diabetes and smoking, are common and may affect health in a number of different ways. Other risk factors such as atrial fibrillation and TIAs are less prevalent and more specific than the common risk factors. Risk factors that have been identified to date only explain approximately 60% of attributable risk of stroke as compared ischaemic heart disease where more than 90% is explained by known risk factors (20;21). Internal carotid artery (ICA) stenosis is a correctable risk factor that is unique to stroke and was first suggested as a risk factor over 50 years ago (22). Although more than 80% of strokes are ischaemic in origin, only 5% are related to ICA stenosis (23;24). Treatment options for both primary and secondary prevention include optimal medical therapy, carotid endarterectomy or carotid stenting.

The first case of coronary angioplasty was published in 1983 and carotid stenting became more popular in the early 1990’s (80). One of the main limitations has been the embolic complications that may arise from such intervention (25;26). Advances in embolic protection device design have contributed to the rapid growth in carotid stenting (27).