Carotid Stenosis

Question 1

Carotid Stenosis

Answer 1

Carotid duplex ultrasound is the primary diagnostic tool for carotid stenosis. A carotid bruit in an asymptomatic patient is an indication for this test.Carotid stenosis (CS) is defined as atherosclerotic narrowing of the extra-cranial arteries (60% to 99%) most often occurring at the bifurcation of the carotid artery with involvement of the proximal internal carotid artery (ICA). Prevalence of the disease is highest among older adults and persons with hypertension and heart disease

Question 2

Carotid Stenosis Symptomatic

Answer 2

Symptomatic CS is manifested by focal neurological dysfunction, including transient ischemic attack (TIA), ischemic stroke, or a range of other subtle but enduring neurological deficits

Question 3

Carotid Stenosis Presentation

Answer 3

Clinical presentation of ischemia in the carotid territory typically includes the following symptoms: contralateral weakness of the face, arm, or leg, or both; contralateral paresthesia of the face, arm, or leg, or both; or transient ipsilateral blindness (amaurosis fugax).

Findings of CVA/TIA are commons

Question 4

Carotid Stenosis Diagnosis

Answer 4

Duplex ultrasound
Bruits are indicator of the need for ultrasound, they do not diagnose
CT Angio if ultrasound not available or inconclusive
MRA can be used, not as accurate

Question 5

Complaint / Finding Red Flag

Answer 5

Loss of vision in one eye or finding a Hollenhorst plaque (cholesterol emobolus in the retinal blood vessel) is a red flag for serious stenosis

Question 6

Carotid Stenosis Management

Answer 6

Statins to get LDL less than 100 (prefer 70)
BP less than 130/80
Antiplatelet if symptomatic - ASA and plavix
Surgical intervention

Question 7

Carotid Stenosis Complications

Answer 7

Bradycardia, hypotension, vasovagal

Neuro impairments

Question 8

Risk factors for asymptomatic carotid stenosis

Answer 8

Hypertension
Tobacco use
Diabetes
Hyper cholesterol
Family History
Age
Obesity
Sleep Apnea