Jan 24, 2023

Carotid Artery Stenosis: When to Refer

Patients with carotid artery stenosis face an elevated risk of stroke and other serious health issues. At the Eastside Neuroscience Institute, our providers specialize in endovascular neurosurgery and interventional neurology, providing skills and expertise not available at other organizations. Here are our guidelines on when to refer for carotid artery stenosis:

Level 1

Appointment within 15 calendar days

Mark urgent on the referral

  • Isolated transient ischemic attack (TIA)
  • Symptomatic internal carotid stenosis of 50% or greater on imaging
  • Symptomatic occluded internal carotid

Level 2

Appointment within 30 calendar days

  • Asymptomatic 80% or greater internal carotid stenosis on imaging
  • Symptomatic internal carotid stenosis of 50% or less
  • Symptomatic subclavian steal syndrome
  • Asymptomatic internal carotid
  • Carotid body tumor

Level 3

Appointment within 90 calendar days

  • Asymptomatic internal carotid stenosis of 50-80% on imaging

Comprehensive Diagnosis

Our providers can diagnose the degree of carotid stenosis, through a comprehensive evaluation, which may include reviewing previous tests, and/or ordering additional tests to ensure the right treatment, at the right time. Test may include one or more of the following:

  • Duplex sonogram of the neck
  • Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) scan of the neck
  • CT angiography (CTa) scan of the neck
  • Angiogram or arteriogram of the carotid arteries

If the tests reveal a stenosis of the carotid artery, our care team will connect with you to consider surgical treatment options.

If the patient presents with a stroke or a TIA, we will assess the degree of carotid stenosis and provide a recommendation upon the severity of the disease.

State-of-the-Art Treatment for Carotid Artery Stenosis

At the Eastside Neuroscience Institute, carotid artery stenosis treatment is a collaborative effort between neurologists, neurosurgeons, vascular surgeons and interventionalists. If a surgical approach is the best option, we may recommend one of two procedures:

  • Microsurgical carotid endarterectomy: During this procedure, we remove plaque from inside the carotid artery and re-establish uninterrupted blood flow to the brain.
  • Endovascular angioplasty and stenting: During this procedure, the care team introduces a balloon into the inside of the carotid artery, displaces the plaque, and places a stent to reinforce the walls.

Top Certifications

Our EvergreenHealth campus is certified as a Comprehensive Stroke Center and our Overlake Medical Center and Clinic campus is certified as thrombectomy-capable center. These certifications validate us as a top regional provider and reflect our exceptional outcomes.  

To refer a patient, please contact:

Bellevue: 425.635.6560  

Kirkland: 425.899.5990

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