Obligatory medical device diagnostics.
- Doppler duplex ultrasonography – To clarify apoplexy risk (risk for stroke), sonography (ultrasonography) is not appropriate for detecting asymptomatic carotid stenosis (narrowing of the carotid artery); there are a high number of false-positive findings in this regard [low-echo plaques are likely to be associated with a higher risk of apoplexy than high-echo plaques]Note: In the presence of extracranial carotid stenosis (narrowing of the carotid artery outside the bony skull (extracranial)), the detection or exclusion of a tandem stenosis (echo-rich plaques are probably associated with a higher risk of apoplexy)Note. Exclusion of a tandem stenosis (consecutively switched stenoses in the same artery) may be useful to provide an individualized treatment indication [guidelines: S3 guideline].
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Magnetic resonance imaging (MRI; computer-assisted cross-sectional imaging (using magnetic fields, that is, without X-rays)), diffusion-weighted or magnetic resonance angiography (MR angio) [if acute or subacute, clinical silent ischemia (reduced blood flow) is detected, the stenosis is considered symptomatic!]
- Computed tomography angiography (CT angio; CTA) – to determine the extent and severity of carotid stenosis.
- Diagnostic selective angiography (DSA) with selective probing of the carotid artery – only if with the non-invasive methods no conclusive statement and a therapeutic consequence results.
Further references [guidelines: S3 guideline]
- Evidence of plaque hemorrhage defined on MRI is associated with a significantly increased risk of cerebral infarction (stroke risk) in patients with asymptomatic carotid stenosis.
- Because of the increased risk associated with stenosis progression, regular follow-up examinations are recommended for patients with >50% asymptomatic carotid stenosis
- An initial follow-up should be performed 6 months after initial diagnosis in patients with > 50% asymptomatic stenosis; if findings remain unchanged, annual follow-up is recommended.
