The natural history of patients with carotid stenosis

Atherosclerosis is a systemic disease affecting the circulatory system throughout the body. Thus, patients with atherosclerosis of the carotid arteries are not only at risk of stroke but also of other manifestations of the disease, i.e. vascular death, myocardial infarction etc. So far, intervention trials evaluating the effect of treatment of this patient group, i.e. by surgical removal of the carotid lesion, has focussed on degree of stenosis of the lesion. However, many other factors may be of importance: local factors of the lesion (morphology, degree of stenosis), hemodynamic factors (collateral compensation) and systemic factors (clinical symptoms, accompanying diseases, risk factor control). Recent findings suggest that plaque morphology (composition and structure) may be of greater importance than the degree of stenosis and it may be speculated if current indications for carotid endarterectomy are optimal.