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Podcast: Audible Bleeding
Episode:

Holding Pressure: Carotid Endarterectomy
Category: Health
Duration: 00:27:24
Publish Date: 2024-02-27 21:19:00
Description:

Authors:

 Sebouh Bazikian - MS4 at Keck School of Medicine of University of Southern California

Gowri Gowda - PGY1 at the University of California Davis Integrated Vascular Surgery Program

Steven Maximus- Vascular surgery attending at the University of California Davis, Director of the Aortic Center

 

Resources: 

  • Rutherford’s 10th Edition Chapters: 88, 89, and 91

  • Houston Methodist CEA Dissection Video:

Part 1: https://www.youtube.com/watch?v=wZ8PzhwmSXQ

Part 2: https://www.youtube.com/watch?v=E_wWpRKBy4w

 

Outline:

 1. Etiology of Carotid Artery Stenosis

  • Risk factors: advanced age, tobacco use, hypertension, diabetes.

  • Atherosclerosis as the primary cause.

  1. Development of Atherosclerotic Disease and Plaque Formation

    • LDL accumulation in arterial walls initiating plaque formation.

    • Inflammatory response, macrophage transformation, smooth muscle cell proliferation.

    • Role of turbulent blood flow at carotid bifurcation in plaque development.

  1. Clinical Features of Carotid Artery Stenosis

    • Asymptomatic nature in many patients.

    • Symptomatic presentation: Transient ischemic attacks, amaurosis fugax, contralateral weakness/sensory deficit.

    • Carotid bruit as a physical finding, limitations in diagnosis.

  1. Importance of Evaluating CAS

    • Assessing stenosis severity and stroke risk.

    • Revascularization benefits dependent on stenosis severity.

  1. Classification of Stenosis Levels

    • Clinically significant stenosis: ≥ 50% narrowing.

    • Moderate stenosis: 50%–69% narrowing.

    • Severe stenosis: 70%–99% narrowing.

  1. Stroke Risk Associated with Carotid Stenosis

    • Annual stroke rate: ~1% for 50-69% stenosis, 2-3% for 70-99% stenosis.

  1. Diagnosis and Screening

    • No population-level screening recommendation.

    • Screening for high-risk individuals as per SVS guidelines.

    • Carotid Duplex Ultrasound as primary diagnostic tool.

    • Additional tools: CT angiography, Magnetic Resonance Angiography.

    • Handling of 100 cm/sec, Internal/Common Carotid peak systolic velocity Ratio > 4.

  1. Revascularization Criteria

    • Symptomatic Patients: 50-69% or 70-99% stenosis, life expectancy at least three or two years, respectively.

    • Asymptomatic Patients: 70% stenosis, considering life expectancy.

  1. Surgical Indications and Contraindications

    • Indications: symptomatic patients, life expectancy considerations.

    • Contraindications: Stenosis
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