Vascular Medicine

Current Diagnostic and Treatment Algorithm for Carotid Artery Disease

Carotid artery disease is narrowing of the carotid arteries, caused by a built-up plaque inside the artery wall that leads to reduced blood flow to the brain. The blockage of these arteries increases the risk of stroke - a medical emergency that occurs when the blood supply to the brain is interrupted or seriously reduced. Arteriosclerotic lesions of the extracranial portion of the carotid artery cause 10–20% of all ischemic strokes (1). 

Until recently the treatment of carotid artery diseases had been controversial. Now, methodologically sound interdisciplinary guidelines exist that allow defining the best treatment option for a patient. In all our partner Clinics in Germany the treatment decisions will be made in Vascular Boards.    

Diagnostic Approach to Carotid Artery Disease

Both for getting a Second Opinion and organizing the treatment in Germany, we need detailed information about the patient. The diagnostic evaluation for overseas patients is usually not complete when they contact us for a second opinion and subsequent treatment recommendations. The system employed by German Health Advisors, however, allows for the completion of this stage while the patient is in his homeland. It is not necessary to come to Germany for diagnostic evaluation. You will be informed if there are any obstacles in the diagnostic processes. For the diagnostic evaluation for Carotid Artery Disease, please bear in mind the following:

  • Medical history,comorbidities, physical examination with neurological status (checking the vision, hearing, balance, coordination, strength and reflexes), blood count and differential, liver and renal function tests (see the request form for German Health Advisors). This will usually be carried out by our local colleagues and documented in the form of a doctor’s letter. 
  •  Carotid Sonography is the most common test for diagnosing carotid artery disease and allows estimation of the extent and severity of extra-cranial carotid stenosis. If a carotid sonography has been performed by your local doctor, please provide us with the report. 
  • Carotid Angiography is considered the gold standard for carotid artery imaging and is needed to define the treatment plan.
  • Computed tomography (CT) angiography is an accurate technique capable of rapid imaging of the carotid artery.
  • Magnetic resonance imaging (MRI) may be an alternative to CT scans for people who need frequent monitoring, to reduce their exposure to radiation.
  • If you want a Second Opinion or you want to come to Germany for the treatment, please obtain your digital radiology images from the facility and send the DICOM filesusing German Health Advisors’secure data transfer system.

Treatment of Carotid Artery Disease

Treatment of Carotid Stenosis consists of medical treatment and surgical management - carotid revascularization (CR), that includes carotid endarterectomy (CEA) and carotid artery stenting (CAS). Both carotid revascularization techniques have their own procedural risks. Therefore, selection of the appropriate treatment for patients with Carotid Stenosis is relatively complicated.Current national and international guidelines contain a strong recommendation for early elective CEA for patients with symptomatic 50–99% stenosis (1). 

In our partner clinics in Germany, usually, a multidisciplinary team of vascular surgeons, cardiologists, neuroradiologists and neurologists discuss each case to define the best treatment strategy for the patients. In this manner, German Health Advisors will help you to get second opinion for your individual case, which should help you make a right decision.  

Follow-Up after the Treatment of Carotid Artery Diseases

Rеgulаr fоllоw-uрcontrols after the trеаtmеnt iѕextremely imроrtаnt fоr Carotid Artery Diseases. Follow-up should be tailored to the individual patient and the stage of the disease. Partner clinics of German Health Advisors schedule the follow-up controls usually as follows:

  • At 2-6 weeks after carotid endarterectomy and carotid artery stenting, carotid duplex ultrasonography should be performed (3). 
  • If the findings from duplex imaging are satisfactory, another duplex study should be done 6 months to 1 year later, then every year thereafter (3).
  • If there is evidence of moderate contralateral disease or recurrent carotid artery stenosis, scanning may be performed at intervals of 6-12 months (3).

Patients, who received treatments in Germany, usually do not need to return to Germany for the follow-up visits. German Health Advisors will provide you with follow-up care through its Telemedicine platform.

 References: 

1. Surgical and Endovascular Treatment of Extracranial Carotid Stenosis. Dtsch Arztebl Int 2017; 114(43): 729-36; DOI: 10.3238/arztebl.2017.0729

2. European Society for Vascular Surgery Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. European Journal of Vascular and Endovascular Surgery 55.1 (2018): 1-2.

3. Carotid Endarterectomy Periprocedural Care. 2018. Source: https://emedicine.medscape.com/article/1895291-periprocedure#b6