Teaching case construct. On examination a bruit is heard over the carotid artery; there are no complaints. This is not yet a stroke and no longer "normal". Atherosclerosis of the brachiocephalic arteries is a separate territory with its own set of complications.
The disease affects the extracranial segments (common and internal carotid, vertebral arteries) and the intracranial arteries. The Kazakhstan Ministry of Health protocol No. 196 includes codes I65 (occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction) and I63 (cerebral infarction) in the scope of atherogenic dyslipidaemias — not because dyslipidaemia equals stroke, but because atherosclerosis of these arteries is part of the same disease.
Clinical masks.
- Asymptomatic carotid stenosis — an ultrasound finding, a bruit, sometimes calcifications on a radiograph.
- Transient ischaemic attack (TIA) — an acute episode of focal neurological (or monocular — amaurosis fugax) ischaemia without infarction, according to the definition used by current stroke documents; a duration "up to 24 hours" is an ageing clinical surrogate. The course does not substitute for a TIA protocol, but names TIA as a complication of atherosclerosis of the precerebral arteries until a cardioembolic or other mechanism has been proven.
- Atherothrombotic cerebral infarction — a consequence of thrombosis on a plaque or of artery-to-artery embolism from a disintegrating plaque of the aortic arch / carotid artery.
- Chronic cerebral ischaemia as a clinical label: memory decline, noise in the head [рус.: шум], dizziness. The Kazakhstan Ministry of Health protocol No. 196 lists these complaints as possible in the cerebrovascular territory, but they are non-specific and by themselves do not prove atherosclerosis.
Duplex scanning of the extracranial segment of the brachiocephalic arteries is named in the Kazakhstan Ministry of Health protocol No. 196 as a method that allows risk to be reclassified from low/moderate to high. ESC/EAS 2025 goes further: an unequivocally documented plaque on carotid or femoral ultrasound (significant, typically ≥50% stenosis) is already a criterion of very high risk as "ASCVD on imaging".
The complications of the territory that you need to be able to name: TIA; ischaemic stroke; residual neurological deficit; post-stroke epilepsy and dementia as consequences of cerebral infarction (not as "stages of atherosclerosis"); cholesterol embolism to the brain — rare, more often after procedures.
The boundary of the lesson. Cardioembolic stroke in atrial fibrillation is not atherothrombosis, even if the same person has plaques. Haemorrhagic stroke is not a complication of an atherosclerotic plaque as thrombosis; the link between arterial hypertension and lipohyalinosis of small perforating arteries is a different mechanism. The course forbids writing "atherosclerosis = any stroke".
The management of carotid endarterectomy and stenting is not covered in this course: this is vascular surgery with its own stenosis thresholds and time windows after an event. The student is required to know that the territory exists, what it is complicated by, and that a carotid bruit is a reason for imaging, not for "vascular drops".