Carotid Artery Disease

Question 2

What is Charcot’s foot?

Answer 2

Question 3

What is the pathophysiology of carotid artery disease and how is it classified?

Answer 3

• Bifurcation of carotid artery predisposes to atheromas and atherosclerosis
• Fatty streak
• Lipid core and formation of fibrous cap
• Classified by the degree of stenosis

Question 4

What are some risk factors for carotid artery disease?

Answer 4

• Age >65
• Smoking
• HTN
• Hypercholesterolaemia
• Obesity
• DM
• CVD
• FHx

Question 5

How does carotid artery disease present?

Answer 5

• Asymptomatic until it causes a stroke or TIA (focal neurological deficit)
• May hear carotid bruit on auscultation
• Even if complete occlusion, if unilateral asymptomatic due to collateral supply from contralateral ICA due to the Circle of Willis

Question 6

Atherosclerosis is the most common cause of carotid artery disease leading to focal neurological deficit. What are some other causes of carotid artery disease?

Answer 6

- Carotid dissection

- Fibromuscular dysplasia

- Vasculitis

• Todd’s paresis (unilateral motor paralysis following seizure)
• Subdural haematoma
• Post ictal state
• Hypoglycaemia

Question 7

If a patient has a stroke what are the investigations carried out?

Answer 7

Initial

- Urgent non-contrast CT to look for infarction

• If thrombectomy being considered then CT head contrast angiography
• Bloods (FBC, U+Es, clotting, lipid profile, glucose)
• ECG (AF)

Follow-Up

• Do Duplex US (Carotid US Doppler) to look for carotid artery stenosis
• Any stenosis within carotid artery can then be looked at with CT angiography

Question 8

How do you manage a patient with a suspected stroke acutely?

Answer 8

• High flow oxygen
• Optimise blood glucose between 4 and 11
• Swallowing screen assessment

Question 9

What long term management should be carried out for patients who have had a TIA or stroke?

Answer 9

- Antiplatelets: 300mg Aspirin for 2/52 then 75mg Clopidogrel longterm

- Statin: high dose atorastatin

- ?Carotid Endarterectomy: for acute non-disabling stroke/TIA if stenosis 50-99%

• Management of HTN and DM
• Smoking cessation
• Regular exercise and weight loss

Question 10

What happens in a carotid endarterectomy and what are the complications of this?

(p.s better than stenting as less risk of long-term major adverse events)

Answer 10

• Done in symptomatic (TIA or stroke) 50-99% carotid artery oclusion

- Remove atheroma and damaged intima

• Reduces risk of future strokes/TIAs

- Complications: stroke, damage to hypoglossal/vagal/glossopharyngeal nerve, MI, local bleeding, infection

Question 11

What are some general complications of a stroke?

Answer 11

• Dysphagia
• Seizures
• Bowel incontinence
• Anxiety and depression
• Cognitive decline