Carotid Stenosis Assessment (NASCET/ECST)
Classifies carotid artery stenosis severity and guides endarterectomy vs stenting vs medical management based on NASCET criteria.
Score interpretation
Stenosis < 50 % (symptomatic or not) or asymptomatic 50–69 % (NASCET). NICE NG128 1.2.5: no surgery for symptomatic stenosis < 50 %.
→ Adults: Antiplatelet therapy (aspirin 75mg or clopidogrel 75mg); high-dose statin; BP and diabetes control. Children: use a children's formulary. Duplex surveillance per local vascular protocol.
Carotid endarterectomy is not indicated for a complete occlusion (ESVS 2023).
→ Best medical therapy (antiplatelet, high-dose statin, BP and diabetes control); if symptomatic, specialist stroke review.
ESVS 2023: endarterectomy may be considered for asymptomatic stenosis in average-risk patients with features of a higher stroke risk on best medical therapy.
→ Best medical therapy for all; vascular MDT decision on endarterectomy in selected patients (life expectancy > 5 years, low procedural risk).
NICE NG128 1.2.4: stable symptoms after non-disabling stroke or TIA with 50–99 % NASCET (70–99 % ECST) stenosis.
→ Assess and refer urgently for carotid endarterectomy (ESVS: within 14 days of symptoms); start best medical treatment now; carotid stenting if endarterectomy is high risk (vascular MDT).
Interpretation bands for the Carotid Stenosis. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Amlodipine · Dihydropyridine Calcium Channel Blocker — Raynaud's / Peripheral Vascular Disease / Hypertension
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Peripheral Arterial Disease · NICE NG19 2012 / ESVS 2017
- Carotid Artery Disease · NICE CG68 / ESVS 2018
- Varicose Veins Management · NICE CG168 2013
- Venous Leg Ulcer Management · NICE NG204 2022
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.