Carotid artery disease

Question 1

What is Carotid artery disease?

Answer 1

Build up of athersclerotic plaque in one or both common and internal carotid arteries resulting in stenos or occlusion

Question 2

What can occur due to carotid artery disease?

Answer 2

ischaemic strokes due to plaque rupture and or atheroemobolism

Question 3

How does an atheroma develop?

Answer 3

Fatty streak, accumulation of a lipid cord and formation of a fibrous cap

Question 4

Why is the bifurcation of the carotid artery a site of atheroma development?

Answer 4

Due to turbulent flow

Question 5

What are the risk factors for carotid artery disease?

Answer 5

age, smoking, hypertension, hypercholesterolaemia, obesity, diabetes melluitus, history of cardiovascular disease, family history

Question 6

What are the clinical features of carotid artery disease?

Answer 6

Asymptomatic but may present as a TIA or stroke

Question 7

What may be present on examination of someone with carotid artery disease?

Answer 7

carotid bruit but this can be carotid stenosis

Question 8

Why is carotid artery likely to be asymptomatic if unilateral?

Answer 8

Due to the collateral supply from the contralateral internal carotid artery and vertebral arteries in the circle of willis

Question 9

What are the differential diagnosis for carotid artery disease?

Answer 9

Carotid dissection, thrombotic occlusion of carotid artery, fibromuscular dysplasia, vasculitis, hypoglycaemia, subdural haematoma, space occupying lesion, venous sins thrombosis, MS,

Question 10

What initial investigations are needed for carotid artery disease?

Answer 10

If suspect a stroke then should get an urgent non-contrast head CT, bloods, ECG for AF, CT head contrast angiography

Question 11

What follow up investigations are need for carotid artery disease?

Answer 11

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

Question 12

What is the acute management for a stroke?

Answer 12

if having a stroke will need high flow oxygen, blood glucose optimisation, swallowing and screen assessment, then depends on if haemorrhage or ischaemic

Question 13

What is the acute management for an ischaemic stroke?

Answer 13

IV alteplase, and 300mg of aspirin, then thrombectomy to intravenous thrombolysis

Question 14

What is the acute management for a haemorrhage stroke?

Answer 14

correction of any coagulopathy and referral to neurosurgery

Question 15

What is the long term management for patients with carotid artery disease?

Answer 15

antiplatelet for 2 weeks after stroke or TIA, statin, hypertension therapy, stop smoking, exercise and weight loss

Question 16

What is carotid endarterectomy?

Answer 16

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

Question 17

What are the complications of a stroke?

Answer 17

Mortality is 12% at 7 days and 19% at 30 days, dysphagia, seizures, ongoing spasticity, bladder or bowel incontinence, depression, anxiety and cognitive decline

Question 18

What are the signs and symptoms of a total anterior circulation stroke (middle or anterior cerebral)

Answer 18

Motor weakness or sensory deficit in 2 or more of face arms legs, homonymous hemianopia, high cortical dysfunction like dysphagia, dyspraxia or neglect

Question 19

What are the signs and symptoms of a partial anterior circulation stoke (middle or anterior cerebral

Answer 19

1 of: 2/3 of TACs criteria, limited motor or sensory defit so 1 of leg, arm or face, high cortical dysfunction alone

Question 20

What are the signs and symptoms of a lacunar stroke?

Answer 20

pure motor in 2/3 (face arm leg) , pure sensory in 2/3, pure sensorimotor in 2/3 ataxic hemiparesis

Question 21

What are the signs and symptoms of posterior circulation strokes?

Answer 21

ipsilateral CN palsy with contralateral motor or sensory defects, bilateral moot or sensory defects, isolated homonymous hemianopia, cerebellar dysfunction