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CRT nonresponder strategy — EECC MCQ

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HardManagement of Heart FailureCRT nonresponder strategyEECC

A 73-year-old has an incidentally detected 72% asymptomatic internal-carotid stenosis despite intensive lipid lowering, antiplatelet therapy and blood-pressure control. Life expectancy exceeds 10 years and local procedural risk is below 3%. Which additional finding most strongly supports considering carotid endarterectomy after neurovascular multidisciplinary review?

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Correct answer: D — Repeated ipsilateral microembolic signals on transcranial Doppler

Carotid revascularisation is not routine for every asymptomatic stenosis. Repeated ipsilateral microembolic signals identify continuing embolic activity and can support carotid endarterectomy in a carefully selected patient with long life expectancy and audited procedural risk below 3%. A contralateral bruit does not localise ipsilateral risk. Stable calcified plaque and normal cerebrovascular reserve are reassuring rather than high-risk features, while isolated carotid intima-media thickening elsewhere is not evidence that this plaque is embolising.

Reference: 2024 ESC Guidelines for peripheral arterial and aortic diseases. https://academic.oup.com/eurheartj/article/45/36/3538/7738955