Carotid artery disease Flashcards
What is Carotid artery disease?
Build up of athersclerotic plaque in one or both common and internal carotid arteries resulting in stenos or occlusion
What can occur due to carotid artery disease?
ischaemic strokes due to plaque rupture and or atheroemobolism
How does an atheroma develop?
Fatty streak, accumulation of a lipid cord and formation of a fibrous cap
Why is the bifurcation of the carotid artery a site of atheroma development?
Due to turbulent flow
What are the risk factors for carotid artery disease?
age, smoking, hypertension, hypercholesterolaemia, obesity, diabetes melluitus, history of cardiovascular disease, family history
What are the clinical features of carotid artery disease?
Asymptomatic but may present as a TIA or stroke
What may be present on examination of someone with carotid artery disease?
carotid bruit but this can be carotid stenosis
Why is carotid artery likely to be asymptomatic if unilateral?
Due to the collateral supply from the contralateral internal carotid artery and vertebral arteries in the circle of willis
What are the differential diagnosis for carotid artery disease?
Carotid dissection, thrombotic occlusion of carotid artery, fibromuscular dysplasia, vasculitis, hypoglycaemia, subdural haematoma, space occupying lesion, venous sins thrombosis, MS,
What initial investigations are needed for carotid artery disease?
If suspect a stroke then should get an urgent non-contrast head CT, bloods, ECG for AF, CT head contrast angiography
What follow up investigations are need for carotid artery disease?
Duplex ultrasound scans gives a good estimate as to the degree of stenos as well as other differentials, then if lesions within carotid artery should do a CT angiography
What is the acute management for a stroke?
if having a stroke will need high flow oxygen, blood glucose optimisation, swallowing and screen assessment, then depends on if haemorrhage or ischaemic
What is the acute management for an ischaemic stroke?
IV alteplase, and 300mg of aspirin, then thrombectomy to intravenous thrombolysis
What is the acute management for a haemorrhage stroke?
correction of any coagulopathy and referral to neurosurgery
What is the long term management for patients with carotid artery disease?
antiplatelet for 2 weeks after stroke or TIA, statin, hypertension therapy, stop smoking, exercise and weight loss
What is carotid endarterectomy?
removal of the atheroma and associated damaged intimal so reduces risk of TIA and stroke, this is done in symptomatic carotid stenos between 50-99% can cause strokes 2-3%, nerve damage, MI, bleeding or infection
What are the complications of a stroke?
Mortality is 12% at 7 days and 19% at 30 days, dysphagia, seizures, ongoing spasticity, bladder or bowel incontinence, depression, anxiety and cognitive decline
What are the signs and symptoms of a total anterior circulation stroke (middle or anterior cerebral)
Motor weakness or sensory deficit in 2 or more of face arms legs, homonymous hemianopia, high cortical dysfunction like dysphagia, dyspraxia or neglect
What are the signs and symptoms of a partial anterior circulation stoke (middle or anterior cerebral
1 of: 2/3 of TACs criteria, limited motor or sensory defit so 1 of leg, arm or face, high cortical dysfunction alone
What are the signs and symptoms of a lacunar stroke?
pure motor in 2/3 (face arm leg) , pure sensory in 2/3, pure sensorimotor in 2/3 ataxic hemiparesis
What are the signs and symptoms of posterior circulation strokes?
ipsilateral CN palsy with contralateral motor or sensory defects, bilateral moot or sensory defects, isolated homonymous hemianopia, cerebellar dysfunction
