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CONDITION/DISORDER SYNONYM

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  • Carotid stenosis

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ICD-9-CM CODE

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  • 433.1 Occlusion and stenosis of carotid artery

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ICD-10-CM CODE

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  • I65.29 Occlusion and stenosis of unspecified carotid artery

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PREFERRED PRACTICE PATTERN

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  • 5D: Impaired motor function and sensory integrity associated with nonprogressive disorders of the central nervous system—acquired in adolescence or adulthood1

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PATIENT PRESENTATION

A 78-year-old male, with a history of TIA, presents for a general physical examination. He is on 81 mg of Aspirin, 40 mg of Lovastatin, and 50 mg of Hydrochlorothiazide. Vitals are: Pulse: 80 Respirations: 16, Blood Pressure: 132/88, Temperature: 98.2°F, and SpO2% of 99%. On physical examination, the physician hears a bruit in the left side of the neck. The patient is sent for carotid ultrasound which reveals 70% blockage of the left carotid and 35% blockage of the right carotid.

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KEY FEATURES

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Description
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  • Carotid arteries become blocked or receive limited blood flow

  • Carotid stenosis: Narrowing of the artery

  • Plaque builds up in the artery

  • Plaque can be stable and asymptomatic

  • Clots can lead to a stroke

  • Can result in a sudden, specific neurological deficit

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Essentials of Diagnosis
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  • Stethoscope on carotid artery, bruit sound

  • Lipid profile

  • Triglycerides test

  • Cerebrovascular accident (CVA) symptoms

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General Considerations
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  • Ischemic (two types)

    • Thrombotic: Atherosclerotic plaques that form at the branching and curves of arteries in the brain can be large vessel thrombosis or small-vessel thrombosis.

    • Embolic: An embolus that forms somewhere other than in the brain, often the heart, and then travels to the brain and restricts or blocks blood flow to the brain.

      • Branches of the middle cerebral artery (MCA) are most commonly affected.

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Demographics
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  • About four million Americans suffer physical impairments and disability from stroke.

  • Two-thirds of all CVAs occur in individuals older than 65 years of age.

    • After age 55, risk of stroke doubles every 10 years.

  • Incidence is greater in men than in women and twice as high in Blacks as in Whites.

  • Cerebral infarction (thrombosis or embolism) is the most common form, accounting for 70% of all strokes, followed by hemorrhages at 20%, and 10% unspecified.

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FIGURE 8-1

Schematic representation of the normal carotid arterial pulse, five types of abnormal pulses, and pulsus alternans. D, diastole; ECG, electrocardiogram; phono, phonocardiogram; S, systole; S1, first heart sound; S2, second heart sound. (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart, 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Unlikely to have any narrowing or blockage of arteries

  • Palpable ...

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