Carotid artery disease

Question 1

Carotid artery disease : Definition

Answer 1

Carotid artery disease refers to the build-up of atherosclerotic plaque in one or both common and internal carotid arteries, resulting in stenosis or occlusion.

Question 2

Carotid artery disease : Pathophysiology

Answer 2

The pathophysiology of carotid artery disease is as for atheroma elsewhere,
* starting with a fatty streak, accumulating a lipid core and formation of a fibrous cap.
* Theturbulent flow at the bifurcation of the carotid artery

Question 3

Carotid artery disease : Clinical features

Answer 3

The majority of carotid artery disease is asymptomatic, but it is also responsible for approximately
* ischaemic strokes, due to plaque rupture
* atheroembolism.

Examination : Carotid bruit secondary to carotid stenosis

Question 4

Carotid artery disease : Investigation

Answer 4

Following Ischaemic stroke or TIA
* Intial Ix : Duplex US of carotids
If lesions or stenosis is seen -
* Gold standard : CT Angiography

Question 5

Carotid artery disease : Management

Answer 5

Indication : Hx of non acute disabling stroke or TAI who have symptomatic carotid stenosis > 50%

Mx : Carotid Endarterectomy within 2 weeks of symptoms