Carotid artery stenosis pathophysiology

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Occlusive Disease of the Subclavian and Brachiocephalic Arteries

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2]

Overview

Embolism of atherosclerotic lesions in the carotid is the most common mechanism of stroke in patients with carotid artery disease. Thrombosis of the cerebral arteries is also a possible, less common cause of stroke.

Pathophysiology

  • Atherosclerotic lesions are commonly located within 2 cm from the bifurcation of the common carotid artery, usually on the posterior wall of the artery. These plaques can extend caudally into the common carotid artery.
  • The presence of atherosclerotic plaque is a risk for developing a stroke, regardless of its location.
  • In addition to compromising the flow to the brain, the plaque can rupture and a superimposed thrombus can develop on the atheroma further exacerbating the stenosis.
  • The emboli then travels upstream until it lodges into a cerebral artery compromising blood supply to the associated territory.

Transient Ischemic Attack

  • Low flow: brief, repetitive attacks
  • Embolic: single, more prolonged episodes

Total Occlusion

  • When the internal carotid artery is totally occluded, it can lead to slow flow or thrombosis. The severity of symptoms depend on the adequacy of the collateral circulation.

Delayed Stroke

  • Occurs many months after carotid occlusion
  • From propagation of the thrombus or embolization of the clot upstream

References

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