Carotid Artery Stenosis

Question 1

What are the risk factors for developing carotid artery stenosis?

Answer 1

Age
Male
Smoking
Hypertension
Diet
Sedentary lifestyle
Raised cholesterol

Question 2

What are patients with carotid artery stenosis at risk of?

Answer 2

Very likely to have arterial disease and atherosclerosis elsewhere

Coronary artery disease
MI

Question 3

How is carotid artery stenosis classified?

Answer 3

Mild Less than 50% reduction

Moderate 50-69% reduction in diameter

Severe 70% or more reduction

Question 4

How does carotid artery stenosis present?

Answer 4

Usually asymptomatic, diagnosed after a TIA or stroke

Carotid bruit
Whooshing sound due to turbulent flow around stenotic area during systole

Question 5

How is carotid artery stenosis diagnosed?

Answer 5

Carotid ultrasound
Initial investigation to diagnose and assess the stenosis

CT or MRI angiogram
Can be used to assess in more detail before surgery

Question 6

How is carotid artery stenosis managed?

Answer 6

Modifiable risk factor reduction

• Healthy diet and exercise
• Stop smoking
• Managing co-morbidities
• Antiplatelet medications (aspirin, clopidogrel, ticagrelor)
• Lipid-lowering medications

Surgical intervention

Question 7

What surgical intervention is used for carotid artery stenosis?

Answer 7

Carotid endarterectomy (first-line treatment for most patients)

Angioplasty and stenting

Question 8

What are the risk factors of carotid artery stenosis?

Answer 8

• Airway compression during surgery due to bleeding
• Facial nerve injury
• Glossopharyngeal nerve (swallowing difficulties)
• Recurrent laryngeal nerve (hoarse voice)
• Hypoglossal nerve injury (unilateral tongue paralysis)
• Stroke, 2% risk

Question 9

What happens in angioplasty and stenting?

Answer 9

Catheter inserted into femoral artery in the groin

Passed through aorta under x-ray guidance to the carotid artery

Balloon inflated to widen the lumen (angioplasty) stent left in place