ABSTRACT
The great majority of cases of carotid artery stenosis result from atherosclerotic disease, with only a small minority being due to other causes including carotid dissection, radiation induced damage, and post-carotid endarterectomy restenosis. Most atherosclerotic carotid stenoses remain asymptomatic. A complex interaction of factors, still incompletely understood, determines whether a particular stenosis becomes symptomatic. The pathophysiology of symptomatic carotid stenosis can be considered as a number of stages, each of which may have differing risk factors and differing opportunities for intervention. These are listed below:
1. early atherosclerotic lesion; 2. progression to plaque and stenosis formation; 3. plaque instability; 4. thrombosis on the ‘‘activated’’ plaque and distal embolization; and 5. intracerebral vessel flow disruption and cerebral infarction.
