BMJ Best Practice Podcast Carotid artery stenosis: an update on diagnosis and management
Nov 11, 2022
Brajesh Lal, a renowned Professor of Vascular Surgery at the University of Maryland and of Neurology at the Mayo Clinic, shares his expertise on carotid artery stenosis. He dives into the intricacies of diagnosis, highlighting diagnostic techniques like ultrasound and velocity analysis. Lal discusses the importance of intensive medical management and explores the debate around screening asymptomatic patients. He provides insights on carotid endarterectomy, potential risks, and the timing of interventions after TIAs, all crucial for effectively preventing strokes.
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Carotid Disease Is Local Atherosclerosis
- Carotid stenosis is an atherosclerotic plaque at the carotid bifurcation that narrows the lumen.
- This plaque commonly causes embolic strokes rather than complete carotid thrombosis.
Use Ultrasound First For Suspected Stenosis
- Use carotid ultrasound as the first-line test after clinical suspicion because it is non-invasive and shows flow velocities.
- Combine waveform velocity analysis with B-mode imaging to assess severity and plaque architecture.
Image Further Before Revascularization
- If revascularization is considered, obtain CTA or MRA for planning and reserve invasive angiography for rare cases.
- Do not rely on bruit alone; follow up with imaging when suspicion exists.