Artery stenosis

Question 1

2 MCC of Renal Artery stenosis

Answer 1

Atherosclerosis (90%) Men 50+ y.o.

Fibromuscular dysplasia (10% ) Women 50+ y.o.

(increased risk in smokers)

Question 2

Pathophysiology of Renal Artery Stenosis:
Narrowing of 1 or 2 renal arteries → 
Obstruction of renal blood flow →
\_\_\_\_ →
\_\_\_\_ →
\_\_\_\_ →
\_\_\_\_ →
Renovascular hypertension (2º HTN)

Answer 2

ischemia →
renin release/ activation of RAAS→
increased aldosterone →
increased sodium retention & SVR →

Question 3

Clinical features of renal artery stenosis:

• HTN despite pt being on ___
• HTN in individuals < __ years of age
• Continuous ____ heard over the flank or epigastrium

Answer 3

1-3 antihypertensives

< 30

Abdominal bruit

Question 4

Renal Artery Stenosis causes new-onset or worsening of renal dysfunction (↑ serum creatinine) after initiating ___ or ___

Answer 4

ACE inhibitors

ARBs

Question 5

Imaging for pts with suspected Renal Artery Stenosis

1º line (screening) tests:
Renal dysfunction present → ____
Normal/near-normal renal fxn → ____

2º line test → catheter angiography

Answer 5

duplex U/S
(or noncontrast MR Angiography)

duplex U/S
(or CTA; MRA w/ gadolinium)

Question 6

In patients with renal dysfunction, there is a risk of:

____ with CTA/catheter angiography
&
Nephrogenic Systemic Fibrosis with MRA gadolinium

Answer 6

contrast-induced nephropathy

Question 7

The site of renal artery stenosis differs according to the underlying cause:

Proximal 1/3 → ____
Distal 2/3 & stenosis/aneurysms → ____

Answer 7

atherosclerosis 
fibromuscular dysplasia (“string of beads”)

*Ipsilateral renal atrophy (small kidneys)

Question 8

Closely monitor serum __ & __ after initiating ACEi or ARBs, especially in patients with bilateral renal artery stenosis.

d/c is new or worsening renal dysfunction

Answer 8

Cr

K+

Question 9

Treatment of Renal Artery Stenosis:

1. antihypertensives
2. ___
3. lifestyle modification

Answer 9

statin

Question 10

Indications for Revascularization procedure in significant renal artery stenosis:
- __ w/ recurrent decompensations

• Acute unexplained ___
• ___ or ___ with worsening renal function

Answer 10

HF
pulmonary edema

Bilateral stenosis/ stenotic single kidney

Question 11

Options for revascularization procedure in renal artery stenosis:

Endovascular revascularization → ____

Surgical revascularization → ____

Answer 11

Percutaneous Transluminal Renal Angioplasty

aortorenal bypass

Question 12

Carotid Artery Stenosis Risk factors:
____
Tobacco use
Diabetes mellitus

Answer 12

Hypertension

Question 13

Clinical features of Carotid Artery Stenosis:
\_\_\_\_\_\_
Ipsilateral \_\_\_\_
Ipsilateral eye pain
Contralateral weakness/ sensory deficits
Carotid bruit
\_\_\_\_ plaque

Answer 13

TIAs/ Strokes
amaurosis fugax (transient vision loss)

Hollenhorst
(yellow cholesterol retinal lesion causing blurry vision/pain )

Question 14

This imaging is indicated for all patients with ischemic stroke or TIA.

Answer 14

Noncontrast CT head or MRI brain

Question 15

First-line imaging modality for suspected symptomatic carotid stenosis

Answer 15

Carotid Duplex Ultrasound

(Focally increased blood flow & peak systolic velocity)

2º line → MRA or CTA

Question 16

For symptomatic carotid stenosis: ___ is typically indicated.

Answer 16

Revascularization

Question 17

For asymptomatic carotid stenosis, consider revascularization for patients with severe carotid stenosis → narrowing of the carotid artery by __

Answer 17

70% - 99%

Question 18

For asymptomatic carotid stenosis management:

1. Lifestyle modifications
2. Long-term __ & __

Answer 18

antiplatelet therapy
statin therapy (high dose)

Question 19

Endarterectomy is contraindicated for patients with carotid stenosis < __%

Answer 19

50%

Question 20

Carotid endarterectomy advantages:

Lower post-surgery __ rates than carotid artery stenting/angioplasty, especially in patients > 70 y.o.

Answer 20

stroke

*stenting/angioplasty is an alternative for pts with increased risk of peri-op complications

Question 21

Carotid endarterectomy is treatment of choice for patients with significant (> __%) or ___ carotid artery stenosis

Answer 21

> 80%

symptomatic stenosis

Question 22

Carotid endarterectomy Post-procedure recommended medication

Answer 22

low-dose aspirin

Question 23

Complications of Carotid endarterectomy

Intraoperative: hemorrhage
postoperative: ___
Inta/post-op: ___

Answer 23

hematoma

stroke