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FAA CACI Carotid/Vertebral Stenosis Worksheet

Pilots with carotid or vertebral artery stenosis can be certified at the AME's office under the FAA's CACI program if the condition is stable without symptoms and imaging shows limited narrowing. This worksheet, updated 01/28/2026, requires imaging within the past year showing 79% stenosis or less on both sides and no clinically significant increase that would change treatment or surveillance.

Who completes it

The AME completes the worksheet from a current, detailed Clinical Progress Note written after a clinic visit with the treating physician or specialist no more than 90 days before the AME exam.

Submitting and payment

How to submit it
If all criteria are met, the AME issues, notes 'CACI qualified Carotid/Vertebral Artery Stenosis' in Block 60 and keeps the documents on file without sending them to the FAA; otherwise the AME defers and submits them.
Who pays
The FAA does not set AME examination fees; the pilot pays the examiner, and the FAA recommends the usual and customary local fee for similar services.

Good to know

  • Accepted imaging is carotid ultrasound, CT angiogram, MR angiogram or angiogram, performed within the previous one year and showing 79% or less on both the right and left.
  • Stenosis under surveillance qualifies, as does surveillance 2 or more years after corrective surgery such as carotid endarterectomy or stenting.
  • Medications may be none, aspirin, or Plavix or Brilinta with aspirin allowed in combination. DOACs, NOACs and coumadin do not qualify for CACI.
  • A history of stroke or TIA is not covered by this CACI; those conditions have their own FAA guidance.

Get the official form

Download the current version from the source each time; forms change without notice.

CACI – Carotid / Vertebral Artery Stenosis Worksheet

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What imaging does the FAA carotid stenosis CACI require?

A carotid ultrasound, CT angiogram, MR angiogram or angiogram performed within the previous year, showing stenosis of 79% or less on both sides. The treating physician's note from the last 90 days must also confirm no clinically significant increase in stenosis that would change treatment or surveillance.

Can a pilot on blood thinners use the carotid stenosis CACI?

Only on antiplatelet therapy. Aspirin, Plavix or Brilinta, with aspirin allowed in combination, are accepted. DOACs, NOACs and coumadin do not qualify for the CACI; the worksheet points those pilots to the Special Issuance guidelines, and the AME defers.