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JAMA Surgery Clinical Challenge
January 2015

Symptomatic Carotid Stenosis

Author Affiliations
  • 1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, Georgia
 

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Surg. 2015;150(1):79-80. doi:10.1001/jamasurg.2014.376

A woman in her early 60s with a history of hypertension and hyperlipidemia was transferred to our hospital after multiple transient ischemic attacks and left internal carotid artery (ICA) stenosis during the past several months. Her most recent presentation was 1 week prior for a minor stroke with amaurosis fugax, slurred speech, right-sided weakness, and facial droop lasting longer than 24 hours. Magnetic resonance imaging of the brain demonstrated subacute infarctions involving the left frontal and parietal hemispheres. She was a current smoker and was taking aspirin and statin medication at the time of presentation. Workup at another facility prior to transfer included computed tomographic angiography of the neck, which showed chronic occlusion of the right ICA and 95% stenosis of the left ICA.

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    1 Comment for this article
    Health care strategies
    J. Geren Nichols, MD | TPMG Fresno, CA
    The first episode this patient had should have been considered a neurologic emergency and a greater improvement in health care would be achieved if that is recognized in the future than learning the rather exotic images and radiographic techniques presented here.
    CONFLICT OF INTEREST: None Reported
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