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Carotid artery disease

Useful management information

  • Advance health directive (where available)
  • Atherosclerosis risk factor management (antihypertensive; diabetes, dyslipidaemia)
  • Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)
  • It is strongly recommended that people who smoke, should stop before surgery as is associated with delayed skin healing. Please consider directing your patient to a smoking cessation program.
  • Commence anti-platelet agent aspirin (clopidogrel if there is allergy or other contraindication to aspirin)
  • Active cholesterol and blood pressure lowering (if appropriate)
  • Transient Ischemic Attack definition

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark “urgent” on your referral

  • Isolated Transient Ischemic Attack (TIA)/stroke, amaurosis fugax
  • Symptomatic internal carotid stenosis of >50% on imaging
  • Symptomatic occluded internal carotid
Category 2
(appointment within 90 calendar days)
  • Asymptomatic internal carotid stenosis of >80% on imaging
  • Symptomatic <50% internal carotid stenosis
  • Symptomatic subclavian steal syndrome
  • Assymptomatic occluded internal carotid
  • Carotid body tumour
Category 3
(appointment within 365 calendar days)
  • Asymptomatic internal carotid stenosis of between 50-79% on imaging 

If your patient does not meet the minimum referral criteria

  • Consider other treatment pathways or an alternative diagnosis
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
    • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential referral information for Carotid artery disease referrals (Referral will be returned without this)

  • Clinical history
  • History of TIAs (motor changes, dysarthria, ocular visual changes)
  • History of risk factors and management
  • Type/location/timing of symptoms (contralateral sensory/motor, monocular visual change)
  • Cardiovascular assessment
  • USS, duplex scan (carotid artery) results
  • BSL & Lipid profile
  • U&E
  • FBC & Coags
  • Homocysteine level
  • HbA1C (if diabetic)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Carotid artery disease referrals

  • No additional information

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 7 October 2022