Carotid Artery Disease

Question 1

What is it?

Answer 1

Build-up of atherosclerotic plaque in one or both common and internal carotid arteries, resulting in stenosis or occlusion.

Question 2

SSx:

Answer 2

Usually asymptomatic, but it is also responsible for approximately 10-15% of ischaemic strokes, due to plaque rupture and/or atheroembolism.

Transient ischaemic attack (TIA)

Stroke – lasts for more than 24 hours without full resolution

Question 3

Investigations:

Answer 3

urgent non-contrast CT head

Bloods, including FBC, U&Es, clotting, lipid profile, and glucose

ECG, especially to check for atrial fibrillation

• Once a diagnosis of ischaemic stroke or TIA is made, it is important to screen the carotid arteries for disease precipitating the presentation. This can be done initially with Duplex ultrasound scans*

Question 4

Management:

Answer 4

• Ischaemic stroke – IV alteplase (r-tPA), if patients are admitted within 4.5hrs of symptom onset and meet inclusion criteria, and 300mg aspirin (orally, or rectal if dysphasic)
• Haemorrhagic stroke – correction of any coagulopathy and referral to neurosurgery (for potential clot evacuation*)
• Thrombectomy is indicated in patients with confirmed acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation on angiography, as well as consideration for intravenous thrombolysis too
• Long term treatment: Antiplatelet, Statin, smoking cessation