Carotid artery stenosis

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Carotid Artery Disease Dr P S Deb

Transcript of Carotid artery stenosis

Page 1: Carotid artery stenosis

Carotid Artery

Disease

Dr P S Deb

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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.

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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

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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

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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)

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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

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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).

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Progression of Carotid stenosis and Event

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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

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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