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Carotid Artery Occlusive Disease
Diagnosis/Definition
Stenosis or ulceration of the carotid arteries. May be symptomatic or asymptomatic.
Initial Diagnosis and Management
- Patients that present with hemispheric transient ischemic attacks (TIA’s), hemispheric cerebrovascular accidents (CVA’s) or transient monocular blindness (amaurosis fugax), should undergo carotid duplex evaluation in the Vascular Surgery Clinic.
- Asymptomatic carotid stenosis is generally discovered during a carotid duplex obtained for a carotid bruit, non-hemispheric symptoms or routine carotid screening.
- Management is based upon the presence or absence of significant occlusive disease of the carotid artery(ies). Initial management should start with duplex imaging of the carotid arteries in the neck.
Ongoing Management and Objectives
- All patients should be encouraged to reduce risk factors and have their co-morbid conditions managed.Specifically, smokers should quit smoking, patients with hyperlipidemia should have this controlled, and those with diabetes should have their disease maximally managed.
- Management of concomitant cardiac and pulmonary disease, which is often associated with carotid artery occlusive disease, should be managed appropriately.
- In individuals who have hemispheric symptoms without evidence of carotid stenosis, search for other causes of the symptoms.
Indications for Specialty Care Referral
Any patient with a hemispheric symptom to include TIA’s, amaurosis fugax, stroke, or evidence of global hypoperfusion of the brain, should be referred to the Vascular Surgery Clinic for carotid duplex imaging.
Any patient with a question of carotid bruit should be referred to the Vascular Surgery Service for screening with carotid duplex imaging.
Patients with asymptomatic high-grade carotid stenosis may be candidates for carotid endarterectomy (CEA) and/or carotid stenting, based on degree of stenosis and associated co-morbid conditions.
Patients with definite hemispheric symptoms ipsilateral to a high-grade carotid lesion should be considered for CEA.
Criteria for Return to Primary Care
Patients without significant carotid stenosis should return to their primary care manager for ongoing management.
Patients undergoing carotid endarterectomy should be followed lifelong in the Vascular Surgery Clinic to monitor their carotid arteries. Patients should be concomitantly followed by their primary care manager to assist in risk factor reduction and management of co-morbidities.
Patients with carotid artery stenosis not requiring CEA should be followed by both the Vascular Surgery Clinic and their primary care manager.
