Table 1.3

Follow-Up or Surveillance for Carotid Artery Stenosis—Asymptomatic

IndicationAppropriate Use Score (1–9)
16.
  • Normal prior examination (no plaque, no stenosis)

I (1)
Surveillance Frequency During First YearAt 3 to 5 monthsAt 6 to 8 monthsAt 9 to 12 months
17.
  • Plaque without significant stenosis of the ICA (plaque, normal ICA velocity)

I (1)I (1)I (1)
18.
  • Mild ICA stenosis (e.g., <50%)

I (1)I (1)I (1)
19.
  • Moderate ICA stenosis (e.g., 50% to 69%)

I (2)U (6)U (6)
20.
  • Severe ICA stenosis (e.g., 70% to 99%)

U (5)A (7)U (6)
Surveillance Frequency After First YearEvery 6 monthsEvery 12 monthsEvery 24 months or greater
21.
  • Plaque without significant stenosis of the ICA (plaque, normal ICA velocity)

I (1)I (3)I (1)
22.
  • Mild ICA stenosis (e.g., <50%)

I (2)U (5)U (6)
23.
  • Moderate ICA stenosis (e.g., 50% to 69%)

I (3)A (7)U (6)
24.
  • Severe ICA stenosis (e.g., 70% to 99%)

A (7)A (7)U (6)

A = appropriate; I = inappropriate; ICA = internal carotid artery; U = uncertain.

  • In the setting of interval development of clinical symptoms in a previously asymptomatic patient or for rapid progression of stenosis during subsequent follow-up (e.g., stenosis category change during a limited period of time), more intensive surveillance may be indicated.

  • Carotid artery occlusion to be addressed in the text of the document. Periodic surveillance duplex ultrasound should be performed according to the severity of stenosis of the contralateral side.