Diagnosis of Internal Carotid Disease

The presence of pacemaker devices and renal failure limit the imaging studies performed in patients with ICA disease. MRIs cannot be performed in patients with pacemakers, and renal failure is a contraindication for both CTA and MRA with gadolinium. Gadoliniumbased contrast agents have been linked to the development of nephrogenic systemic fibrosis and nephrogenic fibrosing dermopathy, often with serious and irreversible skin or organ pathology in patients with moderate to end-stage renal disease.

TREATMENT

Carotid Artery Atherosclerotic Disease

All patients with carotid artery atherosclerotic disease, should be screened for modifiable risk factors, such as hypertension and diabetes, and appropriately treated according to the 2011 AHA/ASA (American Heart Association/American Stroke Association) guidelines, which include dietary changes, increased physical activity, and pharmacologic treatment. Smoking cessation is recommended, and avoidance of environmental tobacco smoke for stroke prevention should be considered in all patients. Statins have been approved for prevention of ischemic strokes in hypercholesterolemic patients with coronary artery disease and, more recently, since the publication of the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, recommended by the 2011 AHA/ASA for patients with atherosclerotic ischemic stroke or TIA without known coronary heart disease to reduce the risk of both subsequent stroke and cardiovascular events. This trial showed a 5-year absolute risk reduction of 2.2% for the combination fatal and nonfatal stroke and of 3.5% absolute risk reduction for major cardiovascular events in patients receiving 80 mg of atorvastatin compared with placebo.

Only gold members can continue reading. Log In or Register to continue