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Carotid Stenosis and Stroke: Historical Perspectives Leading to Current Challenges

Published online by Cambridge University Press:  11 March 2024

David M. Pelz Open the ORCID record for David M. Pelz [Opens in a new window] ,
Allan J. Fox ,
J. David Spence  and
Stephen P. Lownie
David M. Pelz*
Affiliation:
Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
Allan J. Fox
Affiliation:
University of Toronto, Toronto, ON, Canada
J. David Spence
Affiliation:
Neurology and Clinical Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, ON, Canada
Stephen P. Lownie
Affiliation:
Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada Schulich School of Medicine and Dentistry, Western University, Halifax, NS, Canada
*
Corresponding author: D. M. Pelz; Email: [email protected]
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Abstract:

The carotid artery is unique; it is the only vessel to bifurcate into a bulb larger than itself. The history of its anatomic description, understanding of its pathophysiology and evolution of its imaging are relevant to current controversies regarding measurement of stenosis, surgical/endovascular therapies and medical management of carotid stenosis in stroke prevention. Treatment decisions on millions of symptomatic and asymptomatic patients are routinely based on information from clinical trials from over 30 years ago. This article briefly summarizes the highlights of past research in key areas and discuss how they led to current challenges of diagnosis and treatment.

Résumé :

RÉSUMÉ :

Sténose carotidienne et accidents vasculaires cérébraux : facteurs historiques à l’origine de controverses actuelles.

L’artère carotide est unique en son genre, en ce sens qu’elle est le seul vaisseau sanguin à se diviser en un sinus [ou bulbe] plus gros qu’elle-même. Ainsi, l’historique de sa description anatomique, la compréhension que les chercheurs avaient de sa physiopathologie et l’évolution de l’imagerie médicale sont tous des éléments qui permettent de mieux saisir les controverses qui entourent les mesures du degré de sténose ainsi que le traitement chirurgical ou endovasculaire et la prise en charge médicale de la sténose carotidienne en prévention des accidents vasculaires cérébraux. Les décisions relatives au traitement de cette obstruction artérielle chez des millions de patients qui présentent ou non des symptômes reposent généralement sur des données provenant d’essais cliniques effectués il y a plus de 30 ans. Aussi présenterons-nous dans l’article un résumé des faits saillants qui ont marqué la recherche dans le passé dans des domaines clés, et discuterons-nous de la manière dont ces éléments principaux ont conduit aux problèmes actuels de pose de diagnostic et de traitement.

Keywords

carotid artery diseasecarotid endarterectomyhistorystrokestroke imaging
Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 52 , Issue 1 , January 2025 , pp. 20 - 25
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

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