Carotid Disease

Question 1

What percentage of stenosis has to occur before cerebral blood flow becomes impaired?

Answer 1

70%

Question 2

What process allows the brain to compensate for impaired blood flow from stenosis of thecarotid arteries?

Answer 2

Cerebral autoregulation

Question 3

What are complications of unreated carotid disease?

Answer 3

• Small emboli - TIA, Amaurosis fugax
• Large emboli - Stroke

Question 4

What is amaurosis fugax?

Answer 4

TIA of the eye

A painless temporary loss of vision in one or both eyes, which can happen for a number of causes including carotid artery stenosis

Question 5

What may be signs of cartoid artery stenosis?

Answer 5

• Carotid bruit
• Ischaemic events

Question 6

How would you investigate someone for suspected carotid stenosis?

Answer 6

Patients with TIA or Stroke

• Examination - carotid bruit
• Duplex Doppler USS - imaging plus flow

Question 7

How would you treat someone with carotid stenosis?

Answer 7

Medical management: recommended for all patients

• Physical activity
• Cessation of smoking
• Antiplatelet drugs (e.g., aspirin or clopidogrel)
• Statins
• Treatment of hypertension

Carotid endarterectomy (CEA): recanalization of the carotid artery

Question 8

What is carotid endarterctomy?

Answer 8

https://www.youtube.com/watch?v=fGw0oBmmuHM

Surgical procedure that involves incising at the carotid bifurcation longitudinally after clamping the carotid artery, and removing the plaque from inside the artery. A temporary shunt is put in placeto maintain cerebral perfusion. Once removed, that carotid artery is closed by direct suture or patched using a vein or synthetic material to maintain diameter

Question 9

What are the risks of carotid surgery?

Answer 9

• Major stroke/death - 2-3% within 30 days
• TIA
• Haematoma
• Cranial nerve injury - vagus, hypoglossal, mandibular
• MI
• Hyperperfusion syndrome

Question 10

What proportion of strokes and TIAs are caused by carotid stenosis?

Answer 10

20%

Question 11

How soon should symptomatic patients with > 70% stenosis have an endartectomy procedure?

Answer 11

2 weeks of symptom onset

Question 12

Does carotid artery stenosis typically cause vertigo, lightheadedness or syncope?

Answer 12

No

Question 13

What are indications for carotid endartectomy?

Answer 13

Symptomatic patients

• Carotid artery stenosis ≥ 70%

Asymptomatic patients

• Carotid artery stenosis ≥ 80%
• Moderate carotid artery stenosis (60%–79%): depends on patient’s age, sex, and comorbidities