Carotid Artery

Disease

Dr P S Deb

How do you define carotid stenosis

Degree of stenosis: determined by comparing the most narrow linear

diameter of the vessel with the normal internal carotid artery beyond the

carotid bulb in American trial and at bulb in European.

What are the risk factors of carotid stenosis?

• High blood pressure• High cholesterol• Lipoprotein (a)• Low HDL• Smoking• Alcohol• Diabetes mellitus

• Male Sex (2:1)• Old age (>50)• White race (10:1)• Clamidia, HS, CMV,

Helicobactor• Caoagulation factors

VII, VIII, fibrinogen• Sialic Acid, Feretin• Homocystine, Uric acid

What is the incidence of carotid stenosis in the population?Asymptomatic >50% stenosis by ultrasoundAt 50year 0.5%At an above 80years 10%Autopsy40% had carotid plaque10% had carotid blockSymptomatic13% had >70% stenosis

What are the clinical presentation of carotid stenosis?

Asymptomatic Carotid bruit

Silent

Carotid occlusion

Cerebral infarction

(10-40%) Hemispheric/ ocular TIA (10-15%/y)

Acute cerebral infarction(1-6%/Y)

What is the natural course of carotid disease?

Asymptomatic carotid stenosis (Indication of generalized atherosclerosis)

• Stroke 1-6%/year• TIA 10-15%/year• Cardiac events: 20-40%

Proportionate to the severity of stenosis

Symptomatic carotid artery disease

Stroke risk • TIA: approximate 7 % / year

– Hemispheric TIA 12%/year

– Ocular TIA 2%/year

• CVA:  5% to 20% / year • Ulcerated lesion 2-4times more risk

• Recurrent hemispheric events carry a greater stroke risk than a single event (28% versus 12% at 2 years).

Progression of Carotid stenosis and Event

What is the significance of carotid bruit/

• 4% of normal population above 40• 40-70% are haemo dyanamically insignificant• Sensitivity and specificity of severe stenosis

is 60-75%• Stroke or TIA in asymptomatic carotid bruit is

1-3%/year• Routine auscultation of carotid artery is not

recommended

CE in Asymptomatic carotid stenosis

• Stroke reduction by surgery is low 2%

CE if • Progressive lesion on follow-up• Ulcerative lesion• Contralateral carotid occlusion• Ipsilateral silent infarct• Severe stenosis• Associated coronary heart disease