Carotid Artery Disease

Question 1

What are the complications of carotid endartarectomy?

Answer 1

• Stroke or death- 3% risk
• Haematoma
• MI
• Nerve damage:
• XII: Hypoglossal damage –> tongue deviation towards lesion side
• X: Hoarse voice, if bilateral may require tracheostomy
• VII (marginal mandibular): Facial nerve palsy
• Greater auricular: Ipsilateral earlobe numbness
• VIII: Unlikely to be damaged.

Question 2

Where is a carotid bruit heard?

Answer 2

Course of common carotid- medial to SCM in the anterior triangle Best heard in expiration

Question 3

What are the complications of carotid artery disease?

Answer 3

• Amaurosis fugax: Ipsilateral to carotid disease
• TIA: due to microemboli from the plaque
• Stroke: Carotid atheroembolism most common cause.

Question 4

What imaging is useful for carotid artery disease?

Answer 4

Carotid Duplex US: SIte and size of stenosis

MRA: More detailed carotid anatomy

Echo: CVD

CT/MRI brain: Infarcts

Question 5

What is the non-surgical management of carotid disease?

Answer 5

• Aspirin or clopidogrel
• Control risk factors

Question 6

What is the surgical management of carotid disease?

Answer 6

Endarterectomy

Question 7

What are the indications for carotid endarterectomy?

Answer 7

• Symptomatic (ECST european carotid surgery trial, NASCET north american symptomatic carotid endarterectomy trial)
  
  • Carotid stenosis of 70%+: 5% stroke risk per year. 6x reduced stroke risk at 3 years
  • Carotid stenosis of 50%+ if low risk, typically less than 75 years old: less than 3% stroke risk per year
• Asymptomatic:
  
  • Carotid stenosis of 60%+ (benefit less clear?)