Carotid Artery Disease Flashcards
What is the goal of Carotid Artery Stenosis/Disease (CAS) treatment?
Prevent Stroke
What is the danger of CAS?
It is asymptomatic unless the patient has a TIA or CVA.
What is the best test to do if you suspect CAS?
Carotid Duplex: measures velocity of blood flow using sonogram thru the carotid arteries.
(Gold Standard for definitive diagnosis is Angiogram but often the duplex is enough to start treatment).
Which anti-platelet medications are the best for treating CAS?
ASA
Clopidogrel
Which anticoagulant is used for CAS and when?
Warfarrin: only used for carotid dissection
Best medication to reduce risk of stroke in patients with CAS and HTN.
ACE-Is
Best meds to reduce risk of stroke in patients with dyslipidemia and CAS.
Statins
What is the goal for hemoglobin glycation percentage in diabetic patients to reduce the risk of stroke?
HbA1C<7%
When do symptomatic and asymptomatic CAS patients benefit from invasive treatment?
Symptomatic: >50% occlusion
Asymptomatic: >60-80% stenosis
When is the optimal time frame for invasively treating symptomatic patients with CAS?
Within two weeks of onset of symptoms
surgical risk must be less than 6%
How can CAS lead to hyperperfusion syndrome post surgery?
With CAS the brain is HYPOperfused and will try to dilate the carotid arteries to increase blood flow for the demand. This chronic state reduces the vessel’s ability to autoregulate.
After surgery, perfusion is restored but the brain and vessel cannot regulate flow as easily and often HYPERperfusion results.
What can lead to early (<2yrs) restenosis of the carotids after surgery?
Iatrogenic injury, vessel hyperplasia
What can lead to late (>2yrs.) restenosis of the carotids after surgery?
Atherosclerosis or whatever originally caused it.
-higher chance of embolus and stroke
Why can’t stents be used as Tx in patients with renal disease?
The procedure requires contrast which is toxic to kidneys.
