The clinical evaluation and management of carotid insufficiency

Cerebrovascular disease is one of the leading causes of morbidity and mortality in Americans, especially affecting the elderly. Recognition of patients at risk for stroke and transient ischemic accidents may help to decrease the incidence of this significant disease. Identification of carotid insufficiency and the appropriate investigation of its severity in the context of the patient's clinical status is a fundamental skill in stroke prevention. The clinical history and physical examination are the invaluable first steps in assessing the degree of disease. Recognition of risk factors and initiation of medical therapy should be the initial approach. When the severity of symptoms or degree of arterial disease are moderate to severe, surgical intervention, such as carotid endarterectomy, should be considered. The obstetrician- gynecologist, as a primary care physician, must be skilled in the assessment, prevention, and appropriate referral of carotid insufficiency.