Carotid artery disease
Approach
- Expose patients neck
- Inspect
- Palpate
- Percussion
- Auscultation
- Bruit over carotid artries
- Bruit best heard over course of common carotid artery (anterior triangle)
- Bruit best heard in expiration
- Listen over praecordium to ensure not transmitted aortic stenosis murmur
Completion
- Neurological Examination
- Previous CVA
- Check for signs of atherosclerosis elsewhere
Investigations
- General
- Urinalysis: protein, microalbuminaemia
- Blood: FBC (anaemia), biochem (renal function); glucose (DM), cholesterol, homocysteine (increased coaguability)
- ECG: AF, cardiac disease, infarction, ischaemic, LV dysfunction
- Special
- Carotid duplex - atherosclerotic plaques
- Carotid angiography to identify anatomy of carotid arteries
- Echo
- CT / MRI brain - lacunar infarcts
Consequences of carotid stenoses
- Stroke
- Affects intracranial circulation
- TIAS
- Amurosis fugax (curtain falling)
Indications for Carotid endarterectomy
- Symptomatic (>70%)
- Benefit in asymptomatic patients not yet proven
- Surgical complications
- 6-fold reduction in stroke / 3 years
- Operative risk of stroke is 2%, mortality 1-2%
- Specific risks of haematoma, hypoglossal nerve injury, numbness of ipsilateral earlobe
