Medical history (history of illness) represents an important component in the diagnosis of extracranial carotid stenosis (carotid artery stenosis). Family History What is the general health status of your relatives? Are there any diseases in your family that are common? Are there any hereditary diseases in your family? Social history What is your profession? Current … Extracranial Carotid Stenosis: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Hypoglycemia (low blood sugar). Skin and subcutaneous (L00-L99) Vasculitis (vascular inflammation), unspecified. Cardiovascular system (I00-I99) Apoplexy (stroke) Hypertensive encephalopathy – hypertensive emergency characterized by an increase in intracranial (within the skull) pressure with consequent intracranial pressure signs. Reversible cerebral vasoconstriction syndrome (RCVS, synonym: Call-Fleming syndrome); due to constriction (contraction … Extracranial Carotid Stenosis: Or something else? Differential Diagnosis
The following are the most important diseases or complications that can be caused by extracranial carotid stenosis (carotid artery stenosis): Cardiovascular system (I00-I99) Apoplexy (stroke) – the risk of ipsilateral (“on the same side of the body) apoplexy depends on the degree of stenosis; it is: <50% stenosis at <1 percent/year. > 50% stenosis at … Extracranial Carotid Stenosis: Complications
Stenosis grading of the internal carotid artery (internal carotid artery). Degree of stenosis (NASCET definition) [in %]. 10 20-40 50 60 70 80 90 Closure Degree of stenosis, old (ECST definition) [in %]. 45 50-60 70 75 80 90 95 Closure Main criteria 1. b-picture +++ + 2nd color doppler image + +++ + + … Extracranial Carotid Stenosis: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination-including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? Hernias (fractures)? … Extracranial Carotid Stenosis: Examination
1st-order laboratory parameters-obligatory laboratory tests. Total cholesterol, LDL cholesterol, HDL cholesterol. Triglycerides Homocysteine Lipoprotein (a) – lipoprotein electrophoresis, if necessary [in men, a single determination of lipoprotein (a) is sufficient; in women, a determination before and after menopause is required]. Small blood count Inflammatory parameter – CRP (C-reactive protein) Fasting glucose (fasting blood sugar) HbA1c … Extracranial Carotid Stenosis: Test and Diagnosis
Therapeutic target Prevention of apoplexy (stroke). Therapy recommendations Platelet aggregation inhibition, if appropriate; take note: In >50% asymptomatic arteriosclerotic carotid stenosis (narrowing of the vessels supplying the brain): Acetylsalicylic acid (ASA) and statins (cholesterol-lowering drugs). In men, the risk of myocardial infarction (heart attack) and apoplexy (stroke) is reduced by antiplatelet drugs. In symptomatic carotid … Extracranial Carotid Stenosis: Drug Therapy
To prevent extracranial carotid stenosis (carotid artery stenosis), attention must be paid to reducing individual risk factors. Behavioral risk factors Diet Malnutrition and overeating, e.g., excessive caloric intake and high-fat diet (high intake of saturated fat). Micronutrient deficiency (vital substances) – see atherosclerosis / prevention with micronutrients. Consumption of stimulants Alcohol (woman: > 40 g/day; … Extracranial Carotid Stenosis: Prevention
The following symptoms and complaints may indicate extracranial carotid stenosis (carotid artery stenosis): Leading symptoms Retinal ischemia (deficiency of blood supply to the retina). Unilateral paresis (paralysis) Unilateral sensory disturbances Speech/speech disorders Associated symptoms Diplopia (double vision, double images). Cephalgia (headache) Memory impairment Vertigo (dizziness)
Pathogenesis (development of disease) Atherosclerosis (arteriosclerosis, hardening of the arteries) underlies carotid stenosis in more than 90% of cases. Small lesions (injury), which may be present in the arterial wall even at a young age, form the asymptomatic beginning of atherosclerosis. In the first place there is an endothelial cell damage (so-called endothelial dysfunction; endothelium … Extracranial Carotid Stenosis: Causes
General measures Nicotine restriction (refraining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day). Aim for normal weight!Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight … Extracranial Carotid Stenosis: Therapy
Obligatory medical device diagnostics. Doppler duplex ultrasonography – To clarify apoplexy risk (risk for stroke), sonography (ultrasonography) is not appropriate for detecting asymptomatic carotid stenosis (narrowing of the carotid artery); there are a high number of false-positive findings in this regard [low-echo plaques are likely to be associated with a higher risk of apoplexy than … Extracranial Carotid Stenosis: Diagnostic Tests
