Presentation
Previous episodes of TIA.
Patient Data
There are tortuosity and kinking of the proximal left subclavian artery, brachiocephalic artery and proximal right common carotid artery. Atheromatous mixed plaques promote stenosis in the transition of common carotid arteries to the internal carotid arteries:
Right ICA stenosis = ~50%
Left ICA stenosis = >80%
Right vertebral artery is dominant with left vertebral artery terminating as left PICA (hypoplastic).
Case Discussion
Carotid artery stenosis is usually caused by an atherosclerotic process and is one of the major causes of stroke and transient ischemic attack (TIA), such as in this case.
This case was approached using the criteria proposed by the North American Symptomatic Carotid Endarterectomy Trial (NASCET), which demonstrated a conclusive benefit for carotid endarterectomy in patients with symptomatic 70-99% ICA stenosis.
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