Carotid Artery Disease and Stroke: Scoping Review with ☸️SAIMSARA.

Name: SAIMSARA Evidence Object vascular::CAROTID_STROKE_PM
Creator: SAIMSARA
License: https://saimsara.com/license/

SAIMSARA

doi:10.62487/saimsara63d466b1

SAIMSARA Journal

Machine-Readable Science • ISSN 3054-3991

Carotid Artery Disease and Stroke: Scoping Review with ☸️SAIMSARA.

Cardiac & Vascular Health

Issue 1, Volume 1, 2026

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DOI: 10.62487/saimsara63d466b1

Editorial note

• Last update: 2026-04-23 21:05:26

What is this paper about

This paper shows that carotid-related stroke is not primarily a story of narrowing alone, but of vulnerable plaque biology, hidden high-risk lesions, and smarter individualized selection between medical therapy, surgery, and stenting. The full review is worth reading because it maps where modern carotid care is genuinely shifting, from stenosis percentage toward plaque-driven, multimodal stroke risk stratification.

Abstract: To synthesize multi-modal evidence regarding the pathophysiology, diagnostic biomarkers, and comparative outcomes of surgical and endovascular interventions for carotid-related stroke. The review utilises 1904 original studies with 8515101 total participants (topic deduplicated ΣN). The mapped evidence suggests that carotid-related stroke risk is driven less by luminal narrowing alone and more by plaque vulnerability, particularly intraplaque hemorrhage, inflammation, thrombus, and structural lesions such as carotid web; notably, intraplaque hemorrhage was associated with recurrent ischemic events even in mild-to-moderate stenosis (hazard ratio 2.12), and asymptomatic intraplaque hemorrhage was linked to incident stroke (hazard ratio 2.42). This same pattern is reflected in imaging studies where plaque-based models and morphology outperformed stenosis alone, with reported discrimination around area under the curve 0.74-0.90 in selected cohorts. Across treatment topics, carotid endarterectomy remained the benchmark for symptomatic high-grade stenosis, while transcarotid artery revascularization emerged as a promising alternative with low reported 30-day stroke or death rates around 0.8%-2.3% in prospective and registry studies; by contrast, contemporary medically treated asymptomatic stenosis cohorts often showed annual stroke risks below 1%. Clinically, the evidence map supports moving from a stenosis-only framework toward multimodal risk stratification that integrates plaque biology, symptom status, and procedural context when selecting medical therapy, surgery, or stenting. Future research should prioritize standardized prospective validation of plaque-based imaging and biomarker strategies, along with comparative trials in nonstenotic but high-risk carotid disease phenotypes.

Keywords: Carotid artery stenosis; Acute ischemic stroke; Carotid plaque; Non-stenotic carotid disease; Carotid endarterectomy; Intraplaque hemorrhage; Embolic stroke of undetermined source; Carotid revascularization; Intraluminal carotid thrombi; Vulnerable plaque

Review Stats

Final search date and database lock: 2026-04-17 11:47:02 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 8303
Downloaded Abstracts/Papers: 3650
Included original and non-original Abstracts/Papers (all): 2182
Included original Abstracts/Papers (Vote counting by direction of effect): 1904
Reference Index (links used in paper): 252
Total participants (topic deduplicated ΣN): 8515101

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Reference Index (252)

[1] COVID-19-Associated Carotid Atherothrombosis and Stroke. — https://doi.org/10.3174/ajnr.a6752
[2] Nonstenotic Carotid Plaques and Embolic Stroke of Undetermined Source: A Multimodality Review. — https://doi.org/10.3174/ajnr.a7750
[3] Carotid Artery Stiffness: Imaging Techniques and Impact on Cerebrovascular Disease. — https://doi.org/10.3389/fcvm.2022.852173
[4] Risk Stratification and Management of Extracranial Carotid Artery Disease. — https://doi.org/10.1016/j.ccl.2021.06.007
[5] Management of Atherosclerotic Carotid Artery Disease: A Brief Overview and Update. — https://doi.org/10.1016/j.amjmed.2021.09.027
[6] Large artery atherosclerosis: carotid stenosis, vertebral artery disease, and intracranial atherosclerosis. — https://doi.org/10.1212/01.con.0000446104.90043.a5
[7] Intraluminal carotid thrombosis and acute ischemic stroke associated with COVID-19. — https://doi.org/10.1007/s00415-021-10562-1
[8] Orosomucoid, Carotid Plaque, and Incidence of Stroke. — https://doi.org/10.1161/strokeaha.116.013374

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