Carotid artery stenosis a physician detects a carotid bruit, or murmur, over the carotid artery by listening through a stethoscope during a physical exam. For people with symptoms, the American Heart Association recommends initial screening using ultrasound (see diagnosis below). Carotid artery stenosis is usually diagnosed by color flow duplex ultrasound scan of the carotid arteries in the neck. This involves no radiation, no needles and no contrast agents that may cause allergic reactions. This test has good sensitivity and specificity. Typically duplex ultrasound scan is the only investigation required for decision making in carotid stenosis as it is widely available and rapidly
Carotid stenting stenosis of the internal carotid artery. Carotid stenting may be considered an alternative to carotid surgery in average surgical risk patients, albeit with a higher risk of death or stroke as seen in the SAPPHIRE and CREST trials. Features that favor carotid stenting include non-atherosclerotic cause of the stenosis (fibrodysplasia, radiation, early post-surgical stenosis or flap) an experienced center and experienced physician performing the procedure. Features that make stent placement more difficult include significant aortic arch tortuosity, thrombus containing lesions, occluded carotid artery, heavily calcified vessels, symptomatic patients and very tortuous and twisting vessels. None of these affect open, surgical