Carotid Artery Disease Flashcards
1
Q
What is Carotid artery disease?
A
- build up of atherosclerotic plaque in one or both common and internal carotid arteries, resulting in stenosis or occlusion.
2
Q
What is the Px of CAD?
A
- fatty streak, accumulating a lipid core
- formation of a fibrous cap
3
Q
Why is the birufication of the carotid aretry prone of getting atherosclerotic plaque build p?
A
- turbulent flow
4
Q
How would you classify CAD?
A
- radiologically by degree of stenosis
5
Q
Describe the classification of CAD
A
- Mild <50%
- Moderate 50-69%
- Severe 70-99%
- Total Occlusion 100%
6
Q
What are the RF for CAD
A
- age (≥65years)
- smoking
- hypertension
- hypercholesterolaemia
- obesity
- diabetes mellitus
- history of cardiovascular disease
- family history of cardiovascular disease.
7
Q
What are the clinical features of CAD?
A
- Asymptomatic (mostly)
- Focal neurological deficit
- Carotid bruit
8
Q
Why does unilateral CAD present asymptomatically and not have focal neurological deficit?
A
- collateral supply from the contralateral internal carotid artery and the vertebral arteries, via the Circle of Willis.
9
Q
What are the differential diagnosis for CAD?
A
- Carotid dissection
- thrombotic occlusion of carotid artery
- fibromuscular dysplasia
- vasculitis
10
Q
What Ix would you order for CAD?
A
If suspect stroke do
- urgent non contrast CT head
Other Ix
- Bloods
- FBC, U&E, Clotting, lipid profile, glucose
- ECG
- check AF
After stroke is diagnosed
- DUS - estimate degree of stenosis
- CT angiogram - assess disease portion of vessel prior to surgery
11
Q
How would you acutely mx CAD?
A
- high flow oxygen
- blood glucose optimised (target 4-11mmol)
- swallowing screen assessment
If ischaemic stroke
- IV alteplase (r-tPA) - if patients are admitted within 4.5hrs of symptom onset and meet inclusion criteria
- 300mg aspirin - if dysphasic
- Thrombectomy
If haemorrhagic stroke
- correction of any coagulopathy and referral to neurosurgery
12
Q
What is the long term mx of CAD?
A
- CV RF mx
- aspirin 300mg OD for two weeks, then clopidogrel 75mg OD
- aspirin and dipyradimole (if clopidogrel not tolerable)
- atorvastatin 80mg
- aggressive mx of DM and HTN
- Smoking cessation
- Exercise and weight loss
- Cartoid endarectomy
13
Q
What are the criterias for carotid endarectomy?
A
- acute non-disabling stroke
- symptomatic carotid stenosis between 50 – 99%
14
Q
What are the cx of CAD?
A
- death 19% at 30 days
- rehabilitation and dependancy
- dysphagia, seizures, ongoing spasticity, bladder or bowel incontinence, depression, anxiety, or cognitive decline.
