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CQC

72 yo male presenting for follow up physical exam. PMHx:CADHLDM. Medications:VytorinHCTZAmlodipineMetformin. Physical Exam. General: NADHEENT: PERRL, NCAT, CV: S1, S2 RRR no m/g/r or JVD carotid bruitsLungs: CTA no r/r/wAbd: soft, NTND, no organomegalyExtremities: no c/c/e. What

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CQC

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    1. CQC Amit Gossain

    2. 72 yo male presenting for follow up physical exam PMHx: CAD HL DM Medications: Vytorin HCTZ Amlodipine Metformin

    3. Physical Exam General: NAD HEENT: PERRL, NCAT, CV: +S1, +S2 RRR no m/g/r or JVD +carotid bruits Lungs: CTA no r/r/w Abd: soft, NTND, no organomegaly Extremities: no c/c/e

    4. What’s the next step? Cerebral angiography Carotid duplex ultrasound Magnetic resonance angiography Computed tomographic angiography

    5. Clinical Question In what cases is a carotid angioplasty and stent better than carotid endartectomy (CEA)

    6. Indications CEA Symptomatic disease TIA, Amaurosis fugax Asymptomatic disease For stenosis of 60-99%

    7. Decisions 72 yo male with PMHx of HL, HTN, DM. asymptomatic 80% stenosis on ultrasound 54 yo male with PMHx of CAD with recent history of TIAs and 60% stenosis on ultrasound 84 yo male with PMHx of COPD, CAD, DM with bilateral carotid stenosis of 70%.

    8. EVA-3S Hypothesis: CAS not inferior to CEA for treatment of severe symptomatic carotid stenosis.

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