8: CAROTID ARTERY DISEASE

CONDITION/DISORDER SYNONYM

• Carotid stenosis

ICD-9-CM CODE

• 433.1 Occlusion and stenosis of carotid artery

ICD-10-CM CODE

• I65.29 Occlusion and stenosis of unspecified carotid artery

PREFERRED PRACTICE PATTERN

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

KEY FEATURES

Description

• 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

Essentials of Diagnosis

• Stethoscope on carotid artery, bruit sound

• Lipid profile

• Triglycerides test

• Cerebrovascular accident (CVA) symptoms

General Considerations

• 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.

Demographics

• 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.

CLINICAL FINDINGS