Management of Carotid Bifurication Disease
A 72-year-old white male was referred for evaluation and management following the finding of an asymptomatic carotid bruit, picked up on routine physical examination by his primary-care physician. The patient was asymptomatic with respect to ocular or hemispheric ischaemic events. His risk factors included a 30-year history of smoking one pack of cigarettes a day, which he quit a year ago. He had hypertension that was controlled well by two drugs. He had no history of coronary artery disease, diabetes mellitus, or symptoms of peripheral vascular disease. On physical examination, his temporal pulses were equal. His carotid pulses were full and equal, but there was a loud bruit over the right carotid bifurcation. His femoral, popliteal, dorsalis paedis and posterior tibial pulses were normally palpable bilaterally.
Counseling with respect to the nature of carotid territory ischaemic attacks