Chapter 13: Carotid, Subclavian and Vertebral Disease
The following sections are included:
The extracranial arteries are prone to involvement with a number of important atherosclerotic and non-atherosclerotic conditions.
The provision of best medical therapy should not be delegated to the most junior member of the team. It is an essential component of care.
Patients with symptomatic carotid disease benefit from very rapid intervention. Investigative strategies and rapid access to the operating theatre should be geared to ensuring all patients are treated within 2 weeks of suffering their index symptom.
Relatively few patients with asymptomatic carotid disease benefit from intervention (especially females and patients aged >75 years). It is essential that trials identify high-risk subgroups.
The role of several technical aspects of carotid surgery have been guided by large randomised trials.
Patients with symptomatic vertebral stenoses may have a much worse prognosis than was previously thought, but there is no compelling evidence that stenting confers significant benefit over medical therapy.
