Chapter 4: Surgical and Endovascular Approach to Carotid Artery Revascularization
MARIA E. LITZENDORF, MD; MICHAEL R. GO, MD
A 74-year-old male presents for initial outpatient evaluation after a screening carotid duplex was per- formed by his primary care provider. His medical history is significant for hypertension and diabetes. He recently underwent coronary artery bypass using the left internal mammary artery (LIMA). He does not describe focal weakness, amaurosis fugax, or prior stroke. He denies any dizziness, claudication, or paresthesias.
He has smoked one-half pack daily for the last 40 years. His father died at age 65 following an MI, and his mother died at age 83 from complications of COPD. He has one brother with coronary artery disease.
His medications include insulin and atenolol.
On physical exam his vital signs are heart rate 70, blood pressure 130/90. He is neurologically intact, with no deficits. He has soft carotid bruits bilaterally. He has 2+ bilateral pulses throughout.
The carotid duplex shows a 50% stenosis on the left internal carotid artery, and less than 50% stenosis on the right.
Case Study: Chapter 4