Carotid artery disease Flashcards
1
Q
What is CAD?
A
- Build up of atherosclerotic plaque in one or both common and internal carotid arteries
- = stenosis/occlusion
2
Q
Pathophys of CAD
A
- Same as all atheromas
- Fatty streak
- Accumulate lipid core and fibrous cap
- Turbulent at bifurcation prediposes process to occur here specifically
3
Q
Classification of CAD
A
By degree of stenosis:
* Mild - <50% diameter reduction
* Moderate - 50-69% reduction
* Severe - 70-99% reduction
* Total occlusion - 100%
4
Q
RF for CAD
A
- Smoking
- Hypertension
- Hypercholestrolaemia
- Obesity
- Diabetes
- CVD
- FH of CVD
5
Q
Clinica features of CAD presentation
A
- Often asymptomatic
- But can present with TIA/stroke - focal neurological deficit
6
Q
Examination finding for CAD
A
- Carotid bruit - but only associated in less than half of cases
7
Q
Why is CAD often asympomatic even with complete unilateral occlusion?
A
- Collateral supply from contralateral internal carotid artery and vertebral arteries via circle of willis
8
Q
Differentials for other causes of CAD
A
- Atherosclerosis - most common
- Carotid dissection - CTD, younger, trauma/sudden neck movement
- Thrombotic occlusion of CA - presents same
- Fibromuscular dysplasia
- Vasculitis - GCA or Takayasu
9
Q
What is fibromuscular dysplasia?
A
- Non-atheromatous stenotic angiopathy –> hypertrophy of vessel wall
- Young females
- Commonly in renal arteries
- Can present with focal neurological deficit
10
Q
Non-cerebrovascular conditions that can manifest neurologically
A
- Hypoglycaemia
- Todds paresis - unilateral motor paralysis following seizure
- Subdural haematoma
- Space occupying lesion
- Venous sinus thrombosis
- MS
11
Q
Investigations for stroke presentation
A
- Urgent non-contrast CT head
- Assess for infarction
- Bloods - FBC, clotting, lipids, glucose
- ECG - AF?
12
Q
Investigations once diagnosed ischaemic stroke
A
- Image carotids - using duplex USS
- Gives estimate of stenosis
- Can then have CT angiography if needed
13
Q
Acute management stroke - for all
A
- High flow O2
- Blood glucose optimised - target 4-11mmol
- Swallowing screen assessment
14
Q
Ischaemic stroke initial management
A
- IV alteplase IF patients within 4.5hrs of symptom onset + 300mg aspirin (orally or rectally if swallow problem)
15
Q
Haemorrhagic stroke management initial
A
- Correct coagulopathy
- Referral for neurosurgery - clot evacuation?