Carotid occlusive disease: Primary care of patients with or without symptoms

Of the half-million strokes that occur each year in the United States, 20 t o 30% can be directly linked to carotid occlusive disease. The degree of st enosis involving the carotid bifurcation is an important predictor of strok e risk. Asymptomatic disease may be diagnosed on routine physical exam or s creening of the carotid bifurcation in patients with risk factors for ische mic strokes. Symptomatic disease includes transient ischemic attacks, strok e in evolution, and complete stroke. Duplex ultrasound scanning is the stan dard test for the initial evaluation of carotid artery disease. Patients un dergoing surgery should also have magnetic resonance angiography or an angi ogram of the carotid vessels. Stroke prevention includes lifestyle modifica tion such as cessation of smoking, strict dietary and medical management of hyperlipidemia, diabetes, and hypertension. Antiplatelet, anticoagulant, a nd thrombolytic therapy can be used where indicated.