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Stroke
Published in Henry J. Woodford, Essential Geriatrics, 2022
The examination of the vascular system is also relevant. Of particular note is the detection of AF (see Chapter 19) and hypertension (see Chapter 18). Auscultation over the carotid arteries for the detection of carotid bruits is an unreliable way to detect carotid stenosis. It should not be used in the place of carotid imaging and has little value.
Bradyarrhythmias and cardiac pacemakers in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Naktal Hamoud, Fernando Tondato, Win-Kuang Shen
CSM is considered safe, even in elderly patients. The rate of neurologic complication is reported between 0.28% and 0.45% (44). This test, however, should not be performed in patients with carotid bruits, prior history of TIA, stroke, or myocardial infarction in the past 3 months, except if carotid Doppler excludes significant stenosis (45).
Vascular Surgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
A 63-year-old woman presents with a history over the last few months of episodes of left amaurosis fugax. Examination reveals a left-sided carotid bruit. The most appropriate next step is: Carotid endarterectomyCarotid angiographyCT scan brainCarotid Doppler ultrasound (duplex)MR angiography
Asymptomatic retinal emboli and current practice guidelines: a review
Published in Clinical and Experimental Optometry, 2023
Nicole Riese, Yelena Smart, Melissa Bailey
Theoretically, performing auscultation of the ipsilateral carotid artery with a stethoscope on patients with Hollenhorst plaques could help identify a carotid bruit, but results lack sensitivity and positive predictive value and are uncommonly performed in an eye care setting.3,30 Numerous studies have been performed comparing data from the presence of carotid bruits to carotid Doppler results for symptomatic and asymptomatic patients; these studies do not specifically reference retinal emboli but the results are applicable. Presence of a bruit on carotid auscultation has roughly a 25% positive predictive value, meaning one in four patients with a carotid bruit has carotid stenosis of 60% or more.31 The false-negative rate, in this case patients who did not have a carotid bruit but did have significant carotid stenosis confirmed on carotid Doppler, was 44%.31
Rationale for screening selected patients for asymptomatic carotid artery stenosis
Published in Current Medical Research and Opinion, 2020
Kosmas I. Paraskevas, Hans-Henning Eckstein, Dimitri P. Mikhailidis, Frank J. Veith, J. David Spence
According to the 2011 SVS guidelines25, although routine screening in the general population is not recommended, screening for ACS should be considered in certain groups of patients with multiple risk factors that increase the incidence of disease as long as the patients are fit for and willing to consider carotid intervention if significant stenosis is discovered. Such groups of patients include those with evidence of clinically significant peripheral artery disease regardless of age and patients ≥65 years with a history of CHD, smoking and/or hypercholesterolemia25. Patients with carotid bruits (an indicator of not only ACS, but also systemic atherosclerosis, as well as a prognostic indicator of cardiovascular death and MI)26,27 should also be considered for carotid screening. This was a recommendation in the 2009 ESVS guidelines28,29. The 2018 ESVS Guidelines gave a recommendation for selective screening for ACS in patients with multiple vascular risk factors but this was a weak (Class: IIb, Level of Evidence: C) and non-specific recommendation. The 2018 ESVS guidelines also recommended screening for ACS prior to coronary artery bypass grafting (CABG) in patients with a carotid bruit2. Detection of a carotid bruit and/or ACS should be viewed as an opportunity for initiation of intensive BMT, not for offering a carotid intervention, as ACS is not associated with an increased risk of stroke and mortality in patients undergoing CABG30,31.
Successful golimumab therapy in four patients with refractory Takayasu’s arteritis
Published in Modern Rheumatology, 2018
Rie Suematsu, Satoko Tashiro, Nobuyuki Ono, Syuichi Koarada, Akihide Ohta, Yoshifumi Tada
A 21-year-old female patient was diagnosed with TA 5 years ago. She had experienced an absence seizure once a week and felt fatigued. Physical examination revealed bilateral carotid bruits, and laboratory investigations showed elevated ESR and CRP. A CT scan showed wall thickening of the aorta from the ascending aorta to the level of the renal artery and stenosis of the bilateral carotid arteries and the subclavian arteries. TA was diagnosed and CS (30 mg) was commenced. However, her TA relapsed while tapering the CS and the CS dose could not be reduced to less than 22.5 mg/day despite combination with CsA (125 mg daily). IFX (5 mg/kg) and MTX (8 mg/week) were started two years after the diagnosis and induced remission of her TA. CS was tapered off after one year and the patient remained in asymptomatic remission. Three years later, we switched the anti-TNF therapy from IFX to GLM because the patient wished to have subcutaneous injection instead of intravenous infusion. The dose of GLM was increased from 50 to 100 mg because of an increase in inflammatory markers. Thereafter her TA has been in sustained remission. A follow-up CT scan showed improvement of large vessel lesions.