Carotid Disease Flashcards
What percentage of stenosis has to occur before cerebral blood flow becomes impaired?
70%
What process allows the brain to compensate for impaired blood flow from stenosis of thecarotid arteries?
Cerebral autoregulation
What are complications of unreated carotid disease?
- Small emboli - TIA, Amaurosis fugax
- Large emboli - Stroke
What is amaurosis fugax?
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
What may be signs of cartoid artery stenosis?
- Carotid bruit
- Ischaemic events
How would you investigate someone for suspected carotid stenosis?
Patients with TIA or Stroke
- Examination - carotid bruit
- Duplex Doppler USS - imaging plus flow
How would you treat someone with carotid stenosis?
- Anti-platelet therapy
- Carotid endartectomy
- Stenting
What is carotid endarterctomy?
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
What are the risks of carotid surgery?
- Major stroke/death - 2-3% within 30 days
- TIA
- Haematoma
- Cranial nerve injury - vagus, hypoglossal, mandibular
- MI
- Hyperperfusion syndrome
What proportion of strokes and TIAs are caused by carotid stenosis?
20%
How soon should symptomatic patients with > 70% stenosis have an endartectomy procedure?
2 weeks of symptom onset
What cranial nerves are damaged?
- Vagus nerve damage (travels in carotid sheath)
- Recurrent laryngeal nerve (hoarse voice)
- Hypoglossal nerve (deviates towards side of damage
- Facial nerve (drops corner of mouth)
