Carotid artery stenosis Flashcards
What is the main cause of carotid artery stenosis?
Atherosclerosis.
What are complications of carotid artery stenosis?
Stroke / TIA - when parts of the plaque embolise
When is carotid artery stenosis categorised as mild?
Less than 50% reduction in diameter
When is carotid artery stenosis categorised as moderate?
50 - 69 % reduction in diameter
When is carotid artery stenosis categorised as severe?
70% or more reduction in diameter
How does carotid artery stenosis present?
Normally asymptomatic.
Then present with a stroke or TIA.
On examination - carotid bruit
What is a carotid bruit and what causes it?
A whooshing sound heard over carotid artery stenosis.
This is due to turbulent flow around the stenosed area during systole (contraction of the heart)
How is carotid artery stenosis diagnosed?
Carotid ultrasound
CT or MI angiogram may be used for more detail before surgery
How is carotid artery stenosis managed?
Conservative management
- stop smoking
- healthy diet + exercise
- good management of co-morbidities such as diabetes or hypertension
- antiplatelets
- lipid lowering meds - e.g. statins
Surgery - carotid endardectomy (first line)
- angioplasty and stenting
What is involved in a carotid endardectomy?
Incision in the neck
Open the carotid artery
Scrape out the plaque
What are some complications of a carotid endardectomy?
Stroke
Nerve injury (can be temporary or permanent)
- facial nerve - facial weakness
- glossopharyngeal nerve - difficulties swallowing
- recurrent laryngeal nerve - causes a hoarse voice
- hypoglossal nerve - unilateral tongue paralysis
What is an endardectomy?
Surgical opening of a blood vessel to remove an atherosclerotic plaque or blockage
What is an angioplasty?
An endovascular procedure that involves inserting a catheter with a balloon which is then inflated to widen the lumen of the artery.
