Let’s do a quick recap of the patient presented in chapter 1.

A 65-year-old woman with the following cardiovascular Risk Factors:

  • Former smoker
  • Hypertension
  • Type 2 Diabetes Mellitus
  • Hypercholesterolemia

Vascular History:

  • Fontaine stage IIb peripheral arterial disease (PAD) because of left femoro-popliteal occlusion.

Physical Exam:

  • Right carotid bruit, no other neurological symptoms.

Right Carotid: intimal thickening of the common carotid artery with a plaque in the internal carotid artery that conditions a 60% stenosis Left Carotid: atheromatous plaque in the common carotid artery that extends to the internal carotid artery with a PSV of 230 cm/seg and an EDV of 120 cm/seg conditioning an stenosis of 75-80%. Previous DUS showed a bilateral carotid artery stenosis with PSV 200 cm/seg and EDV of 90 cm/seg conditioning an stenosis between of 50-69%

Calcification of the aortic arch as well as the ostium of the supraaortic branches non conditioning of stenosis. Atheromatous plaques in both carotid bifurcations that extends to both internal carotid arteries with a stenosis of the lumen of 60% for the right ICA and 75% for the left ICA. No significant stenosis in the intracranial portion of both carotid arteries. Both vertebral arteries are patent with no significant stenosis.

Other relevant tests

BP: 125/80 mmHg

HR: 75 bpm

BMI: 30

Latest Bloodwork

Parameter

Result

Range

Hemoglobin

13.40 g/dL

12.50-15.50

Platelets

255.000 10^9/L

150,00-400,00

Triglycerides

167 mg/dL

<150

Total Cholesterol

180 mg/dL

<200

     HDL Cholesterol

60 mg/dL

Higher risk >45 mg/dL

     Non-HDL Cholesterol

120 mg/dL

0-130

LDL Cholesterol

90 mg/dL

 

Patient takes the following medication

  • Aspirin 100 mg/day
  • Atorvastatin 40 mg/day
  • Ezetimibe 10 mg/day
  • Bisoprolol 2.5 mg/day
  • Vortioxetine 20 mg/day

Salbutamol 2 puffs If needed

You start with an evaluation of cardiovascular risk management; we can find the latest guidelines on best medical therapy in the 2023 ESVS guidelines on carotid pathology. Let’s take a look:

In this patient we can see she’s on the adequate antiplatelet therapy and cholesterol lowering therapy and her blood pressure is well controlled. You explain the need for and the benefits of cardiovascular risk management and discuss her sedentary lifestyle.

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