Approach

• Expose patients neck

1. Inspect
2. Palpate
3. Percussion
4. Auscultation
   • Bruit over carotid artries
   • Bruit best heard over course of common carotid artery (anterior triangle)
   • Bruit best heard in expiration
   • Listen over praecordium to ensure not transmitted aortic stenosis murmur

Completion

1. Neurological Examination
   • Previous CVA
   • Check for signs of atherosclerosis elsewhere

Investigations

1. General
   • Urinalysis: protein, microalbuminaemia
   • Blood: FBC (anaemia), biochem (renal function); glucose (DM), cholesterol, homocysteine (increased coaguability)
   • ECG: AF, cardiac disease, infarction, ischaemic, LV dysfunction
2. Special
   • Carotid duplex - atherosclerotic plaques
   • Carotid angiography to identify anatomy of carotid arteries
   • Echo
   • CT / MRI brain - lacunar infarcts

Consequences of carotid stenoses

1. Stroke
2. Affects intracranial circulation
3. TIAS
4. Amurosis fugax (curtain falling)

Indications for Carotid endarterectomy

1. Symptomatic (>70%)
2. Benefit in asymptomatic patients not yet proven
3. Surgical complications
   • 6-fold reduction in stroke / 3 years
   • Operative risk of stroke is 2%, mortality 1-2%
   • Specific risks of haematoma, hypoglossal nerve injury, numbness of ipsilateral earlobe 

[Carotid endarterectomy]