Carotid Arterial Disease

1/3 all strokes result from extracranial arterial disease.

Main site of atheroma at bifurcation of the common carotid artery.

Critical narrowing of vessel at 70% or >.
Carotid bruit only heard in minority with TIA

Exam for other arteriopathy eg AAA ,PVD, Hypertension, DM, CRF

Investigations Bloods (FBC, U+E, Lipid, GLU) ECG, Imaging with Doppler studies/duplex USS

When and where to refer

TIA clinic if suspected TIA
Incidental finding of >50% stenosis refer to Vascular Surgery
Urgent referral if Critical narrowing 70%+

Asymptomatic carotid artery stenosis screening

This guidance applies to those 18 years and over.

Screening for carotid artery stenosis should NOT be performed in asymptomatic individuals
There is no indication for asymptomatic screening even in patients with known peripheral vascular disease
Other than to risk stratify patients for coronary intervention, there is no indication for asymptomatic screening of the carotid arteries in patients undergoing other forms of cardiac surgery
There is no routine indication for follow up for asymptomatic patients with carotid artery stenosis

Please note that this guidance is intended as a standard threshold for access. However, if you/ your patient falls outside of these criteria, the option to apply for an Individual Funding Request is still available to you.

Page Review Information

Review update: 02 May 2025 (partial update)

Next review: 02 May 2026

GP speciality lead: Dr Jack Munro-Berry

Contributor: Dr Jack Munro-Berry, GP, CIOS ICB