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Vascular > Carotid Anatomy & Evaluation > Flashcards

Carotid Anatomy & Evaluation Flashcards

1
Q

Where do the left and right carotid originate from?

A

Right: innominate/brachiocephalic
Left: second branch of aortic arch

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2
Q

Where do the carotid arteries terminate?

A

At carotid bifurcation, divide into ICA and ECA

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3
Q

What does the ICA communicate with in the brain?

A

Circle of Willis

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4
Q

What are the intracranial branches of the ICA?

A

1st: ophthalmic artery at carotid siphon (significant curve of distal ICA)
2nd: posterior communicating artery

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5
Q

After the ICA branches into the ophthalmic artery and the posterior communicating artery, what does it become?

A

Middle cerebral artery and anterior cerebral artery

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6
Q

What does the ICA supply?

A

Anterior brain- low resistance
Eyes (ophthalmic), forehead, nose (posterior communicating)

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7
Q

What are the 8 branches of the ECA?

A
  • superior thyroid artery
  • ascending pharyngeal artery
  • lingual artery
  • facial artery
  • occipital artery
  • posterior auricular artery
  • superficial temporal artery
  • maxillary artery
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8
Q

What does the ECA supply?

A

Face, neck, scalp- all high resistance

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9
Q

What arteries originate from the subclavian arteries?

A

vertebrals

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10
Q

What side is the vertebral artery larger on?

A

Left, directly off aortic arch

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11
Q

What happens to the vertebral arteries once they enter the skull at the foramen magnum?

A

Unite to form basilar artery

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12
Q

How long is the basilar artery?

A

3 cm

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13
Q

What does the basilar artery divide into? What does it supply?

A

Divides into posterior cerebral arteries which form part of circle of Willis, supply posterior cranial structures

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14
Q

What is the purpose of the Circle of Willis?

A

Provides collateral pathway that maintains flow to brain in case of stenosis or occlusion

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15
Q

Where is the Circle of Willis located?

A

Base of brain

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16
Q

What arteries make up the Circle of Willis?

A

Hexagonal arrangement of distal ICA, anterior cerebral & posterior cerebral arteries joined by anterior & posterior communicating arteries

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17
Q

When are communicating arteries used?

A

In cases of significant occlusion

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18
Q

How do the anterior cerebral arteries travel? What other vessel do they give rise to?

A

Travel medially toward midbrain (A1), give rise to anterior communicating artery (b/w 2 ACAs), then travel anteriorly

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19
Q

Where are the posterior cerebral arteries located? What do they supply?

A

Wrap around cerebral peduncle, supply posterior hemispheres

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20
Q

What artery is not technically part of the Circle of Willis?

A

middle cerebral artery

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21
Q

How does the MCA travel?

A

Laterally toward temporal bone with numerous branches

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22
Q

What percentage of ICA flow does the MCA carry?

A

75-80%

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23
Q

How does the size of the ACA compare to the MCA?

A

ACA < MCA

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24
Q

What is the most commonly seen collateral pathway?

A

ECA-ICA via orbital and ophthalmic arteries

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25
Q

What is a transient ischemic attack? How long do they last and what is the cause?

A

Fleeting neurologic dysfunction, symptoms < 24 hours, usually embolus from heart or carotid

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26
Q

What is RIND? How long does it last?

A

Reversible ischemic neurologic deficit, symptoms resolve but last over 24 hours, complete recovery

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27
Q

What is VBI? What are the symptoms?

A

Vertebral basilar insufficiency, bilateral symptoms: visual blurring, paresthesia, may have vertigo, ataxia, drop attacks (permanent)

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28
Q

What is CVA?

A

Cerebrovascular accident
Acute: sudden onset of symptoms
Stroke in evolution: symptoms come & go
Completed stroke: no progression or resolution

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29
Q

What are the causes of CVA?

A

Embolism, thrombosis, hemorrhage

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30
Q

What cerebrovascular problems cause transient vs permanent symptoms?

A

transient: TIA, RIND, VBI
permanent: CVA

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31
Q

Where do hemispheric symptoms arise from?

A

Anterior circulation

32
Q

What is aphasia?

A

Inability to speak or express self, left hemisphere if right handed, opposite of dominant side

33
Q

What is dysphasia?

A

Impairment of speech, lack of coordination, failure to arrange proper word order, left hemisphere

34
Q

What is dysarthria?

A

Difficulty articulating speech due to muscle control and slurring, left or right hemisphere

35
Q

What hemisphere is affected with lateralized paresthesia or lateralized weakness?

A

Contralateral hemisphere

36
Q

What hemisphere is affected with hemiparesis?

A

Contralateral hemisphere

37
Q

What is amaurosis fugax?

A

AKA transient monocular blindness, ipsilateral hemisphere or distal ICA

38
Q

What hemisphere is affected when there is motor dysfunction?

A

Right or left contralateral hemisphere

39
Q

What are symptoms of ICA lesions?

A
  • unilateral paresis
  • unilateral paresthesia
  • aphasia
  • amaurosis fugax
  • less likely: myopia AKA nearsightedness, & homonymous hemianopia, defective vision in right or left halves of visual field
40
Q

What are symptoms of MCA lesions?

A
  • aphasia or dysphasia
  • severe facial & arm hemiparesis
  • behavioral changes
41
Q

What are symptoms of ACA lesions?

A
  • severe leg hemiparesis
  • incontinence
  • loss of coordination
42
Q

What are symptoms of vertebrobasilar lesions?

A
  • vertigo
  • ataxia
  • bilateral vision blurring or double vision
  • bilateral paresthesia or anesthesia
  • drop attacks: falling without loss of consciousness
43
Q

What are symptoms of PCA lesion?

A
  • dyslexia
  • coma
  • paralysis unlikely
44
Q

What are symptoms of general posterior circulation disease?

A
  • dizziness, fall
  • syncope
  • dysarthria
  • severe headache
45
Q

Where is palpation of the arteries commonly done?

A

Carotid, superficial temporal, subclavian and axillary

46
Q

Where is auscultation usually performed? Bruit may not be heard in what percentage of stenoses?

A

At carotid or subclavian, not heard in >90% of cases

47
Q

What happens if ICA is occluded?

A
  • thrombosed intra & extracranially
  • no sx
  • ECA can act as collateral for distal ICA & communicate with vert to get blood to brain
48
Q

If the ECA is acting as a collateral for the ICA, how are the waveforms affected?

A

ECA waveforms become low resistance

49
Q

What happens if the CCA is occluded?

A

ICA may still have normal flow due to retrograde flow in ECA & other vessels supplying ICA

50
Q

What happens if ECA occlusion occurs?

A

Not concerning due to numerous branches that act as collaterals

51
Q

When is surgery performed on the vessels?

A

Not for occlusion due to collaterals, surgical intervention for high grade stenosis to relieve high velocities and prevent embolism

52
Q

What is cerebral thrombosis and why does it happen?

A

Thrombus in brain-feeding artery that starves brain of oxygen, blood vessels with increased lipid deposits make blockage more likely

53
Q

What is a cerebral embolism?

A

Thrombus forms elsewhere and travels through vessels, lodges in small vessels of brain, starving brain cells of oxygen

54
Q

What increases risk of cerebral embolism?

A

Irregular heartbeat & hx of heart attack

55
Q

What are 6 additional cerebrovascular conditions?

A
  • atherosclerosis
  • aneurysm
  • dissection
  • fibromuscular dysplasia
  • carotid body tumor
  • subclavian steal
56
Q

What is fibromuscular dysplasia and who does it affect?

A

Condition that causes stenosis & aneurysms of vessels (bead appearance)
MC in young women and affects renal & carotid arteries

57
Q

What is carotid body?

A

Small structure superior to bifurcation that regulates oxygen changes of blood & helps control heart rate by sensing pressure changes

58
Q

What is carotid body tumor?

A

Highly vascular mass that develops between ICA & ECA, supplied by ECA, sx removed

59
Q

What is subclavian steal?

A
  • Subclav stenosis prox to origin of vert
  • Subclav steals blood from vert to supply arm
60
Q

What is the result of subclavian steal?

A

Vertebrobasilar insufficiency = neuro symptoms

61
Q

What are the capabilities of a carotid exam?

A
  • Localize area of blockage, lesion, stenosis
  • Differentiate stenosis from occlusion
  • Document progression of disease
  • Identify surface characteristics
  • Identify pulsatile mass ex. CBT, aneurysm
62
Q

What are limitations for a carotid exams?

A
  • dressings, skin staples, sutures
  • size/contour of neck
  • depth or course of vessels
  • calc shadowing
  • overestimation/underestimation of disease progression
63
Q

What can cause overestimation of disease progression?

A

Accelerated flow due to
- cardiac output
- tortuous vessel
- compensatory flow
- incorrect doppler angle

64
Q

What can cause underestimation of disease progression?

A

Accelerated flow not present due to
- missed acceleration flow jet
- long, smooth plaque formation
- stenosis at bulb
- incorrect doppler angle

65
Q

What are 5 indications for a carotid exam?

A
  • Cervical bruit
  • F/u known carotid disease
  • Evaluation of syncope, seizures, dizziness
  • Evaluation of pt w/ hemispheric neuro symptoms
  • suspected subclavian steal
66
Q

What is plaque of retinal exam called?

A

Hollenhorst plaque

67
Q

What spectral analysis technique is used during carotid evaluation?

A

Fast Fourier Transform: individual frequencies/velocities displayed with time on horizontal axis and various frequency shifts/velocities on vertical axis

68
Q

How can we differentiate the ECA?

A
  • feeds face
  • smaller
  • branches in neck
  • bifurcates anteriorly
  • high resistance
  • temporal tap
69
Q

How can we differentiate the ICA?

A
  • feeds brain
  • larger
  • branches in head
  • bifurcates posteriorly
  • low resistance
  • no response to temporal tap
70
Q

What is the difference in smooth and irregular plaque?

A

smooth: continuous surface w/o irregularities
irregular: discontinuous surface that may contain ulcerations

71
Q

What in intraplaque hemorrhage? What is ulceration?

A

IPH: anechoic area within plaque
ulceration: depression within plaque

72
Q

What does spectral broadening represent?

A

Turbulence & loss of laminar flow, waveform is filled in

73
Q

What do we want to document in a stenosis?

A

Max velocity through narrowest portion of lumen, distal to stenosis: disturbed flow patterns, turbulence, bidirectional flow

74
Q

How can spectral waveform change distal to stenosis?

A

Can become continuous

75
Q

What PSV/EDV correlates with what % of stenosis?

A

< 125 cm/s: normal or 1-15%
> 125 cm/s: 16-49%
> 125 cm/s PSV, < 140 cm/s EDV: 50-79%
> 125 cm/s PSV, > 140 cm/s EDV: 80-99%
Absent: Occluded

76
Q

What can we see when dopplering an occluded vessel?

A
  • CCA may have very low/absent ED flow
  • Evidence of collateralization (ECA exhibiting high EDV)
  • Absent ICA doppler or pre-occlusive thump

Vascular (1 decks)

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