Atherosclerotic Disease of the Carotid Artery Workup

  • Author: Niten Singh, MD; Chief Editor: Vincent Lopez Rowe, MD   more...
 
Updated: Mar 14, 2012
 

Laboratory Studies

  • CBC count
  • Electrolytes, BUN, creatinine
  • Lipid profile
  • Prothrombin time (PT)/activated partial thromboplastin time (aPTT): Heparin is administered during carotid endarterectomy, and knowing the PT/aPTT preoperatively is important.
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Imaging Studies

  • CT scan or MRI of the head: All symptomatic patients should have a scan of the head to rule out other intracranial lesions and identify the presence of new and old cerebral infarcts.
  • Carotid duplex
    • Carotid duplex, with or without color, is the screening test of choice to evaluate for carotid stenosis.
    • Many surgeons operate after seeing the results of a carotid duplex alone if the laboratory has credentials and is validated.
  • Carotid magnetic resonance angiography
    • Carotid magnetic resonance angiography (MRA) has a tendency to overstate the significance of the stenosis.
    • Its exact role is not well defined; it may be useful in collaborating the finding of an occluded carotid with duplex.
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Other Tests

  • Electrocardiogram
    • Evidence of prior myocardial infarction (MI) and ischemic changes are important to identify.
    • The most common cause of mortality following carotid endarterectomy is MI.
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Diagnostic Procedures

  • Arch and carotid arteriography
    • This procedure was used in the NASCET to evaluate the percent of stenosis.
    • The diameter of the narrowest portion of the lesion is divided by the normal internal carotid artery diameter distal to the lesion.
    • This procedure may be associated with a 1-2% risk of stroke.
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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Niten Singh, MD  Assistant Professor of Surgery, Uniformed Services University of the Health Sciences; Chief of Endovascular Surgery, Madigan Army Medical Center

Niten Singh, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Sean D O'Donnell, MD  Director, Department of Surgery, Section of Vascular and Endovascular Surgery, Washington Hospital Center

Sean D O'Donnell, MD is a member of the following medical societies: American College of Surgeons and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

David L Gillespie, MD, FACS, RVT, DMCC, COL, MC  USA Chief and Program Director, Vascular Surgery Service, Walter Reed Army Medical Center; Professor of Surgery, Uniformed Services University of the Health Sciences; Vascular Surgery Consultant, Office of the US Army Surgeon General

David L Gillespie, MD, FACS, RVT, DMCC, COL, MC is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Venous Forum, Eastern Vascular Society, Society for Vascular Surgery, and Southern Association for Vascular Surgery

Disclosure: Nothing to disclose.

James M Goff, MD  Assistant Chief, Department of Surgery, Walter Reed Army Medical Center; Assistant Professor, F Department of Surgery, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences

James M Goff, MD is a member of the following medical societies: American College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard M Stillman†, MD, FACS  Honorary Medical Staff, Northwest Medical Center; Former Chief of Staff and Medical Director, Wound Healing Center, Department of Surgery, Northwest Medical Center

Richard M Stillman†, MD, FACS is a member of the following medical societies: American College of Angiology, American College of Surgeons, Association for Academic Surgery, and Society of University Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center Program Director, Vascular Surgery Residency

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD  Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center Program Director, Vascular Surgery Residency

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

References

  1. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Aug 15 1991;325(7):445-53. [Medline].

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  10. Wiesmann M, Schopf V, Jansen O, et al. Stent-protected angioplasty versus carotid endarterectomy in patients with carotid artery stenosis: meta-analysis of randomized trial data. Eur Radiol. Dec 2008;18(12):2956-66. [Medline].

  11. Kato T, Sakai H, Takagi T, Nishimura Y. Cilostazol Prevents Progression of Asymptomatic Carotid Artery Stenosis in Patients with Contralateral Carotid Artery Stenting. AJNR Am J Neuroradiol. Mar 1 2012;[Medline].

  12. Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Nov 12 1998;339(20):1415-25. [Medline].

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  14. Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trial. Lancet. Jun 2 2001;357(9270):1729-37. [Medline].

  15. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. May 10 1995;273(18):1421-8. [Medline].

  16. Friedman SG. A History of Vascular Surgery. Mount Kisco, NY: Futura Publishing Co; 1989.

  17. Gurm HS, Yadav JS, Fayad P, et al. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. Apr 10 2008;358(15):1572-9. [Medline].

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  20. Inzitari D, Eliasziw M, Gates P, et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. Jun 8 2000;342(23):1693-700. [Medline].

  21. Jackson MR, Chang AS, Robles HA, et al. Determination of 60% or greater carotid stenosis: a prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography. Ann Vasc Surg. May 1998;12(3):236-43. [Medline].

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  24. [Best Evidence] Ringleb PA, Allenberg J, Bruckmann H, et al. 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trial. Lancet. Oct 7 2006;368(9543):1239-47. [Medline].

  25. Wakhloo AK, Lieber BB, Seong J, et al. Hemodynamics of carotid artery atherosclerotic occlusive disease. J Vasc Interv Radiol. Jan 2004;15(1 Pt 2):S111-21. [Medline].

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Arteriogram of the aortic arch and its branches.
Arteriogram of a carotid stenosis.
Atherosclerotic plaque removed at the time of carotid endarterectomy (areas of ulceration with thrombus and intraplaque hemorrhage present).
Carotid artery exposed prior to carotid endarterectomy (coil present in the internal carotid artery).
Carotid artery following endarterectomy and prior to closure (tapered endpoint and smooth appearance of the lumen).
Carotid artery following Dacron patch angioplasty.
Selective left carotid angiogram.
Oblique view of the left carotid artery demonstrating lesion within internal carotid artery.
Placement of stent into internal carotid artery. Note filter wire in upper photos (dots at top of internal carotid artery).
Angioplasty after stent placement; again, note filter wire protecting distal carotid artery.
Completion arteriogram displaying improvement in diameter of internal carotid artery.
Normal carotid arteries on color flow duplex.
Color flow duplex revealing an 80-99% left carotid stenosis and a normal right carotid.
Carotid plaque.
 
 
 
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