carotid artery stenosis
TRANSCRIPT
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