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A diagnosis of an occluded or nearly occluded carotid artery is anxiety provoking for the patient. In these cases, referring physicians often request urgent if not emergent vascular consultation. Because large randomized trials regarding these conditions do not exist, best practices for optimal results require careful history taking, physical examination, appropriate imaging, and careful patient selection. The vascular specialist must have a thorough understanding of the etiology and natural history of an occluded or near-occluded internal carotid artery in order to manage this uncommon presentation of carotid artery disease.
An acute asymptomatic carotid occlusion is difficult, if not impossible, to identify. The asymptomatic patient does not seek medical attention. Moreover, in the absence of symptoms, the timing of the carotid occlusion is difficult to elucidate. Some investigators have attempted to identify changes on computed tomography (CT) that might correlate with a carotid occlusion.
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