Evaluation of Carotid Stenosis

CT scan and MRI are useful for evaluating the question of cerebral infarction which may occur as a consequence of carotid artery stenosis. Infarctions related to internal carotid artery stenosis may be deep, subcortical, or cortical. However, carotid stenosis may exist in the absence of infarction on MRI and CT. The definition of asymptomatic or symptomatic carotid artery stenosis is based upon the history and physical examination, depending on whether or not there are symptoms and signs of carotid territory ischemia. It is important to recognize that in the large clinical trials addressing management of carotid artery stenosis, the detection of "silent" infarcts on CT or MRI did not qualify the stenosis as symptomatic. In clinical practice, however, radiographical evidence of ischemia in the territory of a stenotic internal carotid artery, may affect management.