Diagnosis And Treatment Of Carotid Atherosclerosis
This article reviews the risk factors, clinical manifestations, diagnostic methods, and treatment options for asymptomatic and symptomatic carotid atherosclerosis. The prevalence of carotid atherosclerosis is about 2.5% in the European population, but there are high-risk patients who increase this prevalence substantially.
This article reviews the risk factors, clinical manifestations, diagnostic methods, and treatment options for asymptomatic and symptomatic carotid atherosclerosis.
Who Is At High Risk For Carotid Atherosclerosis?
In the European population, the prevalence of carotid atherosclerosis is about 2.5%, but there are some high-risk patients who may significantly increase this rate. The 12-year Framingham study considered the following risk factors
- Age: the odds ratio increased by about 1.7c/10 years.
- Smoking
- Hypertension
- Hypercholesterolemia
What Are The Top Symptoms Of Carotid Atherosclerosis?
The symptoms of carotid atherosclerosis are related to the formation of blood clots and subsequent embolism, which are listed below.
If the central portion of the retina is damaged, it can cause fugitive melanosis or retinal infarction with a partial or total loss of vision. These signs appear on the same side as the carotid injury.
- Control of lateralized transient cerebral ischemia (weakness or paralysis of the face, arms, and/or legs).
- Loss of sensory and motor function on one or the opposite side of the body in stroke. Increased aphasia or dysarthria if the obstruction is on the right side. If the Willis polygon is intact, internal carotid artery occlusion may remain asymptomatic.
What Is The Initial Evaluation Of A Symptomatic Patient?
A careful history is taken to assess for a history of transient ischemic attack or stroke. History of neck trauma, frontal headache, connective tissue lesions, and possible carotid artery dissection. Usually treated with antiplatelet or anticoagulant medications.
Assessment Of Risk Factors
Depending on the location of the lesion, determine if the patient is right-handed and if it affects the patient’s speech or motor skills.
As secondary prevention, correct blood pressure, dyslipidemia, hyperglycemia (measure glycated hemoglobin), and stimulate physical activity.
What Studies May Help To Exclude Other Diseases?
The first studies are electrocardiogram, prothrombin time (if the patient is on anticoagulants), and flush test to rule out arthritis.
Next, a computed tomography (CT) scan of the brain and, if no lesions are found, a magnetic resonance imaging (MRI) scan. In patients with acute ACL, MRI has a sensitivity of 91% and a specificity of 95%, much higher than CT.
What is the first-line treatment for symptomatic patients? Aspirin therapy is started with a loading dose of 300 mg, followed by statins at 75 mg/day.
How Is A Carotid Aneurysm Diagnosed?
A duplex carotid ultrasound is performed within 24 hours of the visit to detect 0.5 mm thick aneurysms and to quantify the degree of stenosis. This method is quick, safe, and portable. The recommended classification of stenosis is maximum systolic velocity.
The NASCET (North American Symptomatic Carotid Endarterectomy Trial) measure is the current consensus measure of stenosis in the United Kingdom and the United States. The NASCET (North American Symptomatic Carotid Endarterectomy Trial) test is the current consensus measure of stenosis in the United Kingdom and the United States.
In the UK, in addition to duplex ultrasound, which has high sensitivity but moderate specificity, another study has been suggested to confirm the diagnosis before performing endarterectomy, and a 2009 meta-analysis found 86% agreement among sonographers for 70-99% of stenoses diagnosed by duplex ultrasound. The results of this study showed that: Advances in multidetector CT technology have improved diagnostic accuracy, with results similar to enhanced contrast-enhanced MRI in both case series. Moderately symptomatic carotid atherosclerosis is more problematic because of the lower accuracy of measuring stenosis.
Ease of access, cost, contralateral occlusion, significant calcification, and renal insufficiency should be considered when selecting imaging studies. Most centers (and current US recommendations) initially used duplex ultrasound to identify 70-99% of stenoses.
This study is repeated by a more experienced sonographer prior to the procedure. In borderline cases, moderate stenoses, or patients presenting late, multidetector CT arteriography or MRI may reduce unnecessary endarterectomy.
