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
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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
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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%

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4
Q

RF for CAD

A
  • Smoking
  • Hypertension
  • Hypercholestrolaemia
  • Obesity
  • Diabetes
  • CVD
  • FH of CVD
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5
Q

Clinica features of CAD presentation

A
  • Often asymptomatic
  • But can present with TIA/stroke - focal neurological deficit
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6
Q

Examination finding for CAD

A
  • Carotid bruit - but only associated in less than half of cases
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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
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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
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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
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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
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11
Q

Investigations for stroke presentation

A
  • Urgent non-contrast CT head
  • Assess for infarction
  • Bloods - FBC, clotting, lipids, glucose
  • ECG - AF?
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12
Q

Investigations once diagnosed ischaemic stroke

A
  • Image carotids - using duplex USS
  • Gives estimate of stenosis
  • Can then have CT angiography if needed
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13
Q

Acute management stroke - for all

A
  • High flow O2
  • Blood glucose optimised - target 4-11mmol
  • Swallowing screen assessment
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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)
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15
Q

Haemorrhagic stroke management initial

A
  • Correct coagulopathy
  • Referral for neurosurgery - clot evacuation?
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16
Q

When can thrombectomy be performed for ischaemic stroke?

A
  • Confirmed acute ischaemic stroke and confirmed occlusion of proximal anterior circulation on angiography
  • Considered for IV thrombolysis too
17
Q

When is neurosurgery often done for haemorrhagic stroke?

A
  • Not often
  • Unless superficial lobar or ventricular bleed
18
Q

Long term stroke management

A
  • Aspirin for 2 weeks (300mg OD) followed by Clopidogrel 75mg OD long term
  • Statin - high dose
  • Manage HTN and DM
  • Smoking cessation
  • Exercise, active lifestyle and weight loss
19
Q

When to refer to SALT for stroke?

A
  • Any dysphagia or dysphasia
20
Q

When is carotid endarterectomy considered?

Opens up artery and removes plaque

A
  • All patients with acute, non-disabling stroke (or TIA) who have symptomatic cartotid stenosis of 50-99% occlusion
  • –> referral for assessment
21
Q

Carotid endarterectomy surgery

A
  • If eligible, operated on within first 2 weeks following symptoms
  • Halves risk of future stroke - can use Oxford vascular carotid stenosis risk score to determine future risk
22
Q

What does CEA involve?

A
  • Remove atheroma and associated damaged intima
  • = reduced risk of strokes and TIA
23
Q

Risk of CEA

A
  • Ischaemic stroke (2-3%)
  • Nerve damage to hypoglossal, glossopharyngeal or vagus nerve

BUT still superior to carotid stenting

24
Q

Complications of CAD

A
  • Stroke –> dysphagia, incontinence, depression, cognitive decline
  • Rehab can improve this with most occuring between 4-6 weeks but 50% will remain dependent at 1 yr.
25
Q
A