Carotid Artery Stenosis Flashcards
What is carotid artery stenosis?
Carotid artery stenosis is the narrowing of the carotid arteries, typically due to atherosclerosis, leading to reduced blood flow to the brain.
What are the carotid arteries, and where are they located?
The carotid arteries are major blood vessels in the neck that supply oxygen-rich blood to the brain, face, and neck.
What is the main cause of carotid artery stenosis?
The main cause is atherosclerosis, which leads to plaque formation and narrowing of the artery.
What are the common risk factors for carotid artery stenosis?
Risk factors include smoking, hypertension, diabetes, hyperlipidaemia, advanced age, male sex, and a family history of cardiovascular disease.
What are the possible symptoms of carotid artery stenosis?
Many cases are asymptomatic, but symptoms can include transient ischaemic attacks (TIAs), strokes, or amaurosis fugax (temporary monocular blindness).
What is a transient ischaemic attack (TIA)?
A TIA is a temporary disruption of blood flow to the brain, causing stroke-like symptoms that resolve within 24 hours.
What is amaurosis fugax?
Amaurosis fugax is temporary vision loss in one eye caused by reduced blood flow to the retina due to emboli from the carotid artery.
What is the pathophysiology of carotid artery stenosis?
Atherosclerotic plaques narrow the artery, reducing blood flow and increasing the risk of embolisation, which can lead to TIAs or strokes.
How is carotid artery stenosis diagnosed?
Diagnosis is typically made using Doppler ultrasound of the carotid arteries, with confirmation through CT or MR angiography if needed.
What are the imaging features of carotid artery stenosis on Doppler ultrasound?
Doppler ultrasound shows increased flow velocity at the stenosis site, and the degree of stenosis can be graded based on these velocity measurements.
What is the clinical significance of asymptomatic carotid artery stenosis?
Asymptomatic stenosis carries a lower risk of stroke compared to symptomatic stenosis, but it still requires risk factor management to prevent progression.
What are the clinical findings in carotid artery stenosis?
Clinical findings may include a carotid bruit on auscultation, though this is not always present, and neurological deficits in symptomatic cases.
What are the potential complications of untreated carotid artery stenosis?
Complications include stroke, TIA, and permanent neurological disability.
What are the key differential diagnoses for carotid artery stenosis?
Differential diagnoses include intracranial stenosis, vertebrobasilar insufficiency, and other causes of stroke or TIA.
What are the conservative management options for carotid artery stenosis?
Conservative options include lifestyle modifications, such as smoking cessation, regular exercise, dietary changes, and optimisation of blood pressure, glucose, and lipid levels.
What are the medical management options for carotid artery stenosis?
Medical management includes antiplatelet therapy (e.g., aspirin or clopidogrel), statins to lower cholesterol, and antihypertensives to control blood pressure.
What are the surgical management options for carotid artery stenosis?
Surgical options include carotid endarterectomy (CEA) and carotid artery stenting (CAS), particularly for symptomatic patients with significant stenosis.
What is carotid endarterectomy (CEA)?
CEA is a surgical procedure that removes atherosclerotic plaques from the carotid artery to restore blood flow and reduce stroke risk.
What is carotid artery stenting (CAS)?
CAS is a minimally invasive procedure that uses a stent to widen the narrowed carotid artery and improve blood flow.
What are the indications for carotid endarterectomy (CEA)?
CEA is indicated for patients with symptomatic stenosis of 70-99% or for selected patients with asymptomatic stenosis >70%.
What are the potential complications of carotid endarterectomy (CEA)?
Complications include stroke, cranial nerve injury, bleeding, and infection.
How is the risk of stroke reduced in patients with carotid artery stenosis?
Risk reduction involves managing cardiovascular risk factors, antiplatelet therapy, and considering surgical intervention in appropriate cases.
What is the long-term prognosis for patients with carotid artery stenosis?
Prognosis depends on the degree of stenosis, presence of symptoms, and management of risk factors, with appropriate treatment significantly reducing stroke risk.
What is the importance of screening for carotid artery stenosis?
Screening may be considered in high-risk individuals to detect stenosis early, allowing for timely intervention to prevent stroke.
How does smoking cessation benefit patients with carotid artery stenosis?
Smoking cessation reduces the progression of atherosclerosis, decreases stroke risk, and improves overall cardiovascular health.
