Carotid artery disease

Question 1

Define the two types of diseases that can occur in carotid artery disease?

Answer 1

1. Transient ischemia
   - occlusion of the cerebral artery where symptoms last less than 24hours
2. Stroke
   - rapid cerebral occluson where symptoms last more than 24hours

Question 2

Which is the most common cause in aetiology and what does it involve?
List the other 2 factors too

Answer 2

Cerebral infarction (84%)

• AF
• Endocarditis
• Drug abuse
• MI
• Haemotological

Also includes:
primary intracerebral hemorrhage and subarachnoid hemorrhage

Question 3

Give a rough list of the risk factors involved in aetiology

Answer 3

Obesity
Age
Smoking
Diabetes
FH
Hypertension/lipidaemia 
Male

Question 4

Very generally, what is the reasons in its pathophysiology?

Answer 4

Thrombi/Emboli
Haemorrage
Any occlusion

Question 5

In pathophysiology, what is the relationship behind velocity and radius of vessel? Then state what happens to velocity when stenosis is <50%, 50-70% and 70-79% and 80-89%?

Answer 5

As radius decreases, velocity increases

Stenosis: 
<50% = <125cm/s
50-70%=>125cm/s
70-79%=>270cm/s
80/89%=>140cm EDV

Question 6

What are the examinable clinical features?

Answer 6

Neurological - collateral symptoms like paralysis, viscuspatial neglect
Cardiac
Auscultate carotids

Question 7

What imaging tools can be used in investigation?

Answer 7

CT = see vessels and whether there is a blockage

Carotid USS

Question 8

What is the treatment general non-surgical involved?

Answer 8

Smoking caessation
Control of hypertension
Diabetic control

Drugs =
Statin and antiplatlet

Question 9

Who does carotid endarterectomy benefit?

Answer 9

It benefits those with >70% stenosis

Question 10

Explain the process for determining whether endarterectomy is undertaken for assymptomatic stenosis?

Answer 10

Patient with TIA or non-disabling stroke is candidate so undergoes carotid imaging within 1 week

Determine whether significant or not (sig if 70% according to ECST criteria or more narrowing) *NASCET says 50%

If NS with stable neurological and symtoms = best medical treatment

If S but stable neuro/symtoms = best medical treatment

If S + not stable = carotid endarterectomy and stenting

Question 11

How could perioperative stroke occur?

Answer 11

Plaque rupture
Hypoperfusion
Virchows triad = raw intimal surface + thrombosis

Question 12

What is the NNT for within 2 weeks,2-4,4-12 and longer 12weeks (time of surgery)?

Answer 12

within 2 weeks = 5
2 to 4weeks = 10
4 to 12weeks = 18
longer than 12weeks =125

Question 13

What is the best time to get operated on after getting diagosed? (in terms of surgery postpone)

Answer 13

within 2 weeks/ASAP

Question 14

Who is carotid surgery offered to particularly?

Answer 14

All those with symptomatic >70% stenosis EXCEPT those with occlusion too

Question 15

Who is considered for surgery?

Answer 15

Male with 50-69% stenosis

asymptomatic stenosis >70% (anyone)

Question 16

Is the surgery prophylactic?

Answer 16

YES!
form of surgery whose purpose is to minimize or prevent the risk of developing cancer in an organ or gland that has yet to develop cancer and is known to be at high risk of developing cancer.