Q. The carotid duplex results indicate that Iain has carotid stenosis. Please indicate which of the following actions are Appropriate or Inappropriate for each of the options listed below.
Q. The carotid duplex results indicate that Iain has carotid stenosis. Please indicate which of the following actions are appropriate or inappropriate for each of the options listed below.
Reassure the patient that the “symptomatic artery” has only a 40% stenosis which is not severe enough to benefit from an operation – Inappropriate – the symptomatic artery is the 85% narrowed right ICA.
Ask for a confirmatory scan of the carotid arteries – Appropriate – the accuracy of carotid doppler varies considerably between operators. Most places would confirm the degree of stenosis by repeating the doppler, or carrying out an MR angiogram or CT angiogram with contrast.
Ask the patient’s GP to refer the patient to the vascular surgeon – Inappropriate – carotid endarterectomy is far more effective if done very soon after the stroke or TIA. This delay will increase the risk of stroke!
Ring up the vascular surgeon to discuss Iain’s case – Appropriate – this is likely to result in the earliest possible date for carotid endarterectomy.
Ask the interventional radiologist to put a stent into the narrowed carotid artery – Inappropriate – although this is technically feasible trials have not yet shown that it is as effective as surgery in preventing strokes.
Tell the patient that the presence of a narrowed carotid artery is associated with a higher risk of future stroke – Appropriate – this is true. He will have a significantly higher risk of stroke in next five years. Carotid artery stenosis risk calculation tools are available.
Page last reviewed: 18 Jan 2021
