Carotid Disease

Question 1

What is the primary intervention for asymptomatic carotid stenosis?

Answer 1

Risk factor control - healthy diet, smoking cessation, exercise

Question 2

What drug therapy is most effective in stroke prevention?

Answer 2

Statins - high intensity atrovastatin

Question 3

Which patients will endarterectomy be considered?

Answer 3

60-90% stenosis
Stroke/death risk of unit <3%
Life expectancy >5 years
>1 imaging characteristic associated with high stroke risk

Question 4

Name four carotid territory signs

Answer 4

• hemimotor/sensory signs
• transient monocular blindness
• higher cortical dysfunction
• failure to resolve within 24 hours

Question 5

What is the name for the transient monocular blindness?

Answer 5

Amaurosis fugax

Question 6

If there is no source of embolism who should patients with amaurosis fugax be referred to?

Answer 6

Ophthalmology due to risk of optic nerve head ischaemia

Question 7

How is stroke risk assessed?

Answer 7

ABCD2 score
Age >60
BP>140/90
Clinical features (unilateral weakness/speech disturbance)
Diabetes
Duration of symptoms (>1hr)

Question 8

Name vertebrobasilar symptoms

Answer 8

• bilateral blindness
• gait/stance
• motor/sensory signs
• dysarthria
• homonymous hemianopia
• diplopia/vertigo/nystagmus

Question 9

What is the post TIA treatment?

Answer 9

Dual antiplatelet therapy
Aspirin 300mg + clopidogrel/dipyridamole

Question 10

What are the key risk of carotid endarterectomy?

Answer 10

Cranial nerve injury
Post-op stroke
Bleeding/haematoma
BP problems
Patch infection
Restenosis