Aneurysms 2 - carotid disease Flashcards
What is associated with Atherosclerosis of the carotid arteries
transient ischaemic attacks and ischaemic stroke
What is the function of the carotid arteries
Carotid arteries are the blood vessels that carry oxygenated blood to the head, brain and face, located on each side of the neck
What is the aetiology of cerebral infarction in the cause of a stroke
clot blocking arteries (plaque rupture/thrombosis) endocarditis, MI, carotid artery trauma/dissection drug use, sickle cell haemotological disorders Atrial fibrillation
What is the aetiology of an ischaemic event
clot blocking arteries, endocarditis, MI, carotid artery trauma, drug use, sickle cell haemotological disorders
What is the definition of Transient Ischaemic Attack
Focal CNS disturbance caused by vascular events such as microemboli and occlusion leading to cerebral ischaemia. Symptoms last less than 24 hours and there are no permanent neurological sequelae.
What is the definition of stroke
Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
What is the pathophysiology of a carotid disease
Original Atherosclerotic plaque forms which is at risk of rupture = thrombus
When thrombus dislodges, it causes TIAs/stroke
Carotid disease is a systemic disease therefore what can it further cause
claudication, ulcers, stroke, etc
What does the likelihood of a Atherosclerotic plaque rupturing in carotid disease dependant on
Virchow triad
What is the diagnose of carotid artery atherosclerosis dependant on
History
Examination
CT
Carotid Ultrasound scan
What does measuring the velocity of flow indicate in diagnosing carotid artery atherosclerosis
suspected stenosis
What does a greater velocity indicate about the radius of the vessel
As radius of a vessel decreases (i.e. stenosis), velocity increases.
How is brain still able to be perfused in a TIA or an occluded internal carotid artery
Brain is still perfused due to circle of willis
What imposes the risk of further stroke occurring in a TIA or an occluded right internal carotid artery
emboli being showered from high velocity flow in a diseased carotid artery, causing distal ischaemia.
NO FLOW = NO EMBOLI
What is the purpose of Carotid endaterectomy and how does it occur
PROPHYLACTIC - prevent disease occurring
an incision is made to open the carotid artery, plaque is removed, then the repaired artery is closed
What is the general complications of Carotid endaterectomy
Wound infection, bleeding, scar, anaesthetic risks
Nerve damage: vagus, hypoglossal, glossopharyngeal giving hoarseness of the voice
What is the nearby nerves that can be damaged in Carotid endaterectomy
vagus, hypoglossal, glossopharyngeal (giving hoarseness of the voice)
How can the complication of Perioperative stroke occur
Plaque rupture sending clot further up
Hypoperfusion- circulatory shock
Virchow’s triad – raw intimal surface and thrombosis e.g. change in vessel wall
What is an alternative medical therapy used in the treatment of carotid disease
stenting
How does the procedure of stenting occur
Artery is cannulated by putting wire through and releasing a stent
What is the concerns in stenting
Main concern is putting wire through initially
and not putting healthy artery above and below at risk
What percentage of stenosis should surveillance and surgery be the management
Surveillance - Less than 50% stenosis
Surgery - Stenosis above 70%
What therapy has higher risk of stroke and heart attack
Stroke - stenting
Heart attack - surgery
When would you consider operating on asymptomatic patients
CEA should be considered for asymptomatic patients with high grade carotid stenosis >70%
Asymptomatic CEA should only be performed by operators with a low (<3%) perioperative stroke or death rate
What is the riskiest period for further event
within the first two weeks
