Asymptomatic carotid stenosis is generally discovered during carotid duplex obtained for carotid bruit or non-hemispheric symptoms.
Management is based upon presence or absence of significant occlusive disease of the carotid artery.
Initial management should be duplex imaging of the carotid and vertebral arteries in the neck. All patients should be encouraged to reduce risk factors and have their comorbid conditions managed. Specifically, smokers should quit smoking, patients with hyperlipidemia should have this controlled, and those with diabetes should have their disease maximally managed. Management of concomitant cardiac and pulmonary disease, which is often associated with carotid artery occlusive disease, should be managed appropriately. In individuals who have hemispheric symptoms without evidence of carotid stenosis, search for other causes of the symptoms.