Carotid Artery Disease

Question 1

Define Tia

Answer 1

Focal neurological deficit involving specific vascular territory with symptoms <24 hours

Question 2

Define stroke

Answer 2

Focal neurologic deficit involving specific vascular territory with symptoms > 24 hours

Question 3

Name 10 causes tia/stroke (carotid artery complications)

Answer 3

• Most common = atherosclerotic plaque in carotid bifurcation! Other more rare:
• HIV vasculitis
• takayasu
• fibromuscular dysplasia
• post radiation carotid stenosis
• giant cell arthritis
• Moyà Moyà disease
• carotid dissection
• carotid aneurysm
• neurofibromatosis
• carotid kinks and coils

Question 4

Name 10 risk factors carotid artery disease

Answer 4

• Ht most common
• current smoking
• obesity
A poor diet and physical activity
• elderly
• male
• black
• diabetes
• high cholesterol
• coronary artery disease
• prior stroke or Tia

Question 5

Symptoms carotid artery disease? (10)

Answer 5

• transient monocular blindness (amourosis fugax)
Symptoms tia/stroke:
• hemiparesis (weak)
• hemi paralysis
• hemi sensory deficit
• dysphasia

• isolated syncope (blackout)
• pre-syncope ( feel faint)
• isolated double vision (diplopia)
• isolated vertigo
(Differential for these = cardiac, inner ear path)

Less common = dizzy, deteriorate mental intellect and memory

Question 6

Clinical findings carotid artery disease?

Answer 6

• Audible bruit
• rare:pale optic disc on fundoscopy

Question 7

Name 5 high risk features on ultrasound of carotid artery disease?

Answer 7

• Hypo echoic plaque
• intraplaque haemorrhage
• ulceration
•Floating thrombus
• thin fibrous cap

Question 8

Name 4 indications for surgical management of carotid artery disease?

Answer 8

• mild (<50% stenosis) symptomatic disease with thrombus in ICA or CCA (high risk embolization ) or with large ulcer on atherosclerotic plaque (>4mm, increased risk thrombosis)
• moderate (50-69% stenosis) symptomatic disease (patient must be fit and surgeon stroke rate <3%)
• severe (70-99%, stenosis) asymptomatic (patient must be male <75 and surgeon post-op stroke rate <3%) and symptomatic ( fit for surgery and stroke rate <6.%)

Question 9

Which patients with carotid artery disease get best medical therapy only? (2)

Answer 9

• Mild (<50%stenosis) asymptomatic
• moderate (50-69 % stenosis) asymptomatic

Question 10

Name 2 surgical treatment options for carotid artery disease

Answer 10

• Carotid end-arterectomy : direct carotid exposure, carotid arteriotomy, remove plaque and close with synthetic or autologous patch
• carotid stenting