Carotid Artery Disease - TIA/ Stroke

Question 1

What are the causes of stroke?

Answer 1

Cerebral infarction due to MI, atrial fibrillation, atherosclerosis plaque rupture/ thrombus, endocarditis, carotid artery dissection, drug abuse, haemotological disease e.g. sickle cell disease
Inter-cerebral haemorrhage
Sub arachnoid haemorrhage

Question 2

How is the diagnosis of TIA or stroke investigated?

Answer 2

History
Examination; neurological, cardiac and auscultation of carotid
CT and CT angio
Carotid Doppler (detect clots in carotid)

Question 3

Describe the relationship between velocity and stenosis.

Answer 3

A decrease in vessel radius = increase in velocity of blood flow
Velocity <125cm/s = < 50 % stenosis
Velocity > 125 cm/s = 50-69% stenosis
Velocity > 270cm/s = 70-79% stenosis
End diastolic velocity > 140 cm/s = 80-99% stenosis

Question 4

What is the criteria for being considered for surgery?

Answer 4

Surgery for all symptomatic patients with > 70% stenosis
Surgery is considered for males with stenosis 50-69%
Surgery isn’t given if there is total occlusion

Question 5

Why is surgery not considered if there is total occlusion?

Answer 5

If a person is able to recover from a total occlusion of the carotid artery, then their brain is still able to be fully perfumed from the vertebral arteries and the one carotid artery and the circle of Willis.
Therefore there is no need to operate.
If there is total occlusion = no flow then there is no risk of embolus.

Question 6

What is the best medical treatment given?

Answer 6

Treatment for modifiable risk factors:
Control hypertension
Control diabetes
Smoking cessation
Statins
Anti platelet

Question 7

What is the main aim of surgery?

Answer 7

Surgery is prophylactic

Question 8

What are the complication of carotid endarectomy?

Answer 8

General: bleeding, wound infection, pain, scar, an aesthetic risks, nerve damage (recurrent laryngeal nerve)
Other; perioperative stroke due to hypoperfusion, plaque rupture, raw intimacy surface causing thrombus.