7. Carotid Bruit
• Right Carotid Bruit discovered IP Day 4
• Stat Doppler US -> 80 – 99% Stenosis R
• Additional Meds: Asa + Statin
• No Associated Neuro Symptoms
• Px Scheduled 7/22/13 SDS R CEA
14. CAD <-> CAS
J Am Coll Cardiol. 2011;57(7):779-783.
doi:10.1016/j.jacc.2010.09.047
The severity of CAS and the extent of coronary
artery disease (CAD) were significantly correlated (r
= 0.255, p < 0.001). Independent predictors of
severe CAS defined by PSV were the presence of
left-main or 3-vessel CAD, increasing age, a history
of stroke, smoking status, and diabetes mellitus.
15. LVH -> CAS?
Heart and Vessels
May 2013, Volume 28, Issue 3, pp 277-283
This study shows that the presence of LVH and
higher EAT thickness together improves prediction
of CPs in hypertensive patients with 0–1 risk factor
and that those with ≥2 RFs show high prevalence of
CPs independently of LVH and/or EAT.
16. CAS Signs/Symptoms
• Asymptomatic -> -> -> TIA -> -> -> CVA
• Neurologic Deficits
-Dependent on Path of Emboli
-Contalateral Hemiparesis/Paralysis
-Contralateral Sensory Deficits
-Aphasia (Afluent vs. Fluent)
-Visual Field Defect(s)
-Amaurosis Fugax
22. Carotid Endarterectomy
• Indications
- Symptomatic
One or more transient ischemic attacks (TIAs) in the
preceding 6 months and carotid artery stenosis exceeding
50%
Ipsilateral TIA and carotid artery stenosis exceeding 70%, combined with required coronary
artery bypass grafting (CABG)
Progressive stroke and carotid artery stenosis exceeding 70%
Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid
Endarterectomy Trial Collaborators. N Engl J Med. Aug 15 1991;325(7):445-53.
- Asymptomatic
Good Risk Pxs with > 60% Stenosis
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. May 10
1995;273(18):1421-8.
23. Medical Management
May 7 issue of the Annals of Internal Medicine
Tufts Medical Center, Boston, Massachusetts.
"The medical management of patients with asymptomatic
carotid stenosis has improved significantly over the past 20
years, with stroke rates having come down markedly,"
coauthor David E. Thaler, MD, PhD, commented to Medscape
Medical News. "While there may be a role for invasive
approaches such as stenting and endarterectomy in high-risk
patients, it is not clear if these interventions are superior to
medical therapy in the modern era; more work is needed to
better identify high-risk patients and to test the interventional
approaches in this group."
