Carotid Artery Stenosis Article

Question 1

Symptomatic vs asymptomatic CAS

Answer 1

CAS - 20% of ischemic stroke
Can be asymptomatic or symptomatic - including amurosis fugax.

Usually ICA plaque rupture and embolization. Usually anterior.
Stenosis of external usually not asso with stroke.

Symptomatic. = neuro ischemia +ICA stenosis >50%. Usually TIA, then stroke. Elevated risk for next 6 months following stroke.

Asymptomatic - last 6 months no neurological deficits.

Question 2

Imaging

Answer 2

USCD. - relies on skill of sonographer.

CT angiography useful for srigical planning.

Question 3

Management of CAS related neurological ischemia.

Answer 3

Urgent vascular referral via ED.
Minimise recurrence from unstble plague
Carotid endarterectomy gold standard.
Recrruent risk 9-15% vs just medical therapy >25%
Stenosis <49% - no benefit.
Ideally within 2 weeks.
highest risk recurrence - 2 weeks.
High risk - 6 weeks.
Antiplatelet therapy - discuss with vascular.

Stenting 2nd line, but not preferred as high risk of periop stroke.

Question 4

Management of asymptomatic.

Answer 4

Antiplatelet therapy - usually aspirin monotherapy
Statin
CVD risk modification
Smoking cessation.
BP control
Refer >80% for non urgent review.

Question 5

Management of chornic occlusion

Answer 5

Same as asymptomatic, but do not need referral to vascular surgery.

Question 6

Follow up post CEA

Answer 6

CDUS - 4-6 weeks then 6 months. If normal risk of restenosis is low.

Complications
Hypoglossal, glossopharyngeal, vagus nerves.