What is the typical treatment for a clinically significant carotid artery stenosis?

The typical treatment for clinically significant carotid artery stenosis, especially when the stenosis is greater than 70% in symptomatic patients or greater than 80% in asymptomatic patients, is carotid endarterectomy. This surgical procedure involves the removal of atherosclerotic plaques from the carotid artery to improve blood flow and reduce the risk of stroke.

Carotid endarterectomy has been shown to significantly decrease the incidence of stroke in patients with substantial stenosis who exhibit symptoms such as transient ischemic attacks (TIAs) or stroke, as well as in asymptomatic patients with high-risk criteria. The procedure is indicated as it effectively restores normal arterial blood flow and addresses the underlying cause of the stenosis.

Medication management can play a role in the overall treatment of carotid artery disease, particularly in managing risk factors, but it is not sufficient as a standalone treatment for significant stenosis. Stenting may be an option in some cases, particularly for those who are high-risk surgical candidates, but it is generally considered secondary to surgery when feasible. Watchful waiting is typically reserved for patients with minimal stenosis or those who are asymptomatic without significant risk factors, thus not suitable for cases defined as clinically significant.