Carotid artery disease

Question 1

what is the flow of the carotid

Answer 1

Common> internal> circle of willis

Question 2

2 main types of strokes and their 2 subtypes

Answer 2

1. ischemic (80%)
   - embolic
   - thrombotic
2. hemmoragic
   - intracerebral
   - subarachnoid

Question 3

***what is issue in ischemic stroke and what is it not

Answer 3

NOT a flow probem - circle of willis provide collateral

IS and embolic problem

Question 4

what are types of stroke based on time

Answer 4

TIA - symtoms

Question 5

what are stroke NOT

Answer 5

brain claudication

Question 6

what are risk factors for all atrokes

Answer 6

• age
• Male
• athero
• smoking
• HT
• DM
• afib, carotid dis

Question 7

what percent of strokes due to carotid

Answer 7

at least 33% - major

Question 8

2 classes of carotid plaques

Answer 8

1. symtoomatic

2. asymotomatic

Question 9

3 ways to diagnose carotid stenosis

Answer 9

1. PhX
2. US
3. angiography

Question 10

2 main Sx of carotid stenosis

Answer 10

1. weakness/numbness in arm/leg on CONTA side

2. amarosis fugax (eye) in IPSI side

Question 11

what is seen on US

Answer 11

• velocity recordings

- calcification shadows

Question 12

what is issue with angio

Answer 12

regular - 1% risk of stroke
CTA - limited brain info
MRA - good images of arteries, nice brain

Question 13

what is major way to distinguish how to Tx

Answer 13

presence of Sx

Question 14

3 possible Tx

Answer 14

1. med- anti-platelet
2. carotid endartectomy
3. carotid stenting

Question 15

adv and disadv to stenting

Answer 15

adv - local only, lower MI risk

dis - stroke rate close to 10%

Question 16

what is Tx algorithm for symotomatic

Answer 16

NOT CONTROVERSIAL

• CEA for over 50% stenosis
• no benefit for under 50% - meds

Question 17

what is Tx algorythm for asymmtomatic

Answer 17

CONTROVESIAL

• CEA for over 60% - modest benefit
• no benefit under 60

Question 18

4 groups that have higher stroke rate in asymtomatic and should consider CEA

Answer 18

1. men
2. younger
3. high grade contralateral lesion
4. ulcerated or echolucent lesion

Question 19

what to do for occluded

Answer 19

no risk because no blood flow

Question 20

what is subclavian steal syndrome

Answer 20

block in sublavian
> need blood from vertebrate for R arm
> when use R arm get dizzy

Question 21

Tx of steal syndrome

Answer 21

almost always benign