Carotid artery disease is a significant contributor to morbidity in diabetic patients, requiring optimal medical management and revascularization for high-grade stenosis despite slightly higher perioperative risks.
In diabetic patients with carotid artery disease, intensive medical management and appropriate revascularization (primarily carotid endarterectomy) are crucial for mitigating the high risk of cerebrovascular events.
Carotid artery disease is a significant contributor of diabetic patients' morbidity and mortality driven by its strong association with ischemic stroke. The link between carotid atherosclerosis and cerebrovascular or coronary artery disease is otherwise well established pointing to a high risk patient. This link gets particularly important in diabetic patients who demonstrate high rates of silent cardiovascular events, as a means of early detection of underlying atherosclerotic disease. Carotid ultrasonography now allows clinicians to visualize the characteristics of the carotid wall and lumen surfaces, to quantify the severity of local and systemic atherosclerosis and better guide the intensity of primary and secondary prevention strategies. Carotid revascularization remains the standard of care for high grade stenosis and while higher perioperative events and restenosis rates may be anticipated the benefits derived from the procedure still outweigh the risks. Current guidelines recommend carotid endarterectomy as a gold standard procedure; however carotid artery stenting can be a valid alternative in high medical risk symptomatic diabetic patients. Optimal glycemic control and confounding risk factor management can ameliorate short and longer term adverse events.
Siddiqui et al. (Tue,) conducted a review in Carotid artery disease in diabetic patients. Carotid artery disease is a significant contributor to morbidity in diabetic patients, requiring optimal medical management and revascularization for high-grade stenosis despite slightly higher perioperative risks.