Carotid artery disease Flashcards
what is the flow of the carotid
Common> internal> circle of willis
2 main types of strokes and their 2 subtypes
- ischemic (80%)
- embolic
- thrombotic - hemmoragic
- intracerebral
- subarachnoid
***what is issue in ischemic stroke and what is it not
NOT a flow probem - circle of willis provide collateral
IS and embolic problem
what are types of stroke based on time
TIA - symtoms
what are stroke NOT
brain claudication
what are risk factors for all atrokes
- age
- Male
- athero
- smoking
- HT
- DM
- afib, carotid dis
what percent of strokes due to carotid
at least 33% - major
2 classes of carotid plaques
- symtoomatic
2. asymotomatic
3 ways to diagnose carotid stenosis
- PhX
- US
- angiography
2 main Sx of carotid stenosis
- weakness/numbness in arm/leg on CONTA side
2. amarosis fugax (eye) in IPSI side
what is seen on US
- velocity recordings
- calcification shadows
what is issue with angio
regular - 1% risk of stroke
CTA - limited brain info
MRA - good images of arteries, nice brain
what is major way to distinguish how to Tx
presence of Sx
3 possible Tx
- med- anti-platelet
- carotid endartectomy
- carotid stenting
adv and disadv to stenting
adv - local only, lower MI risk
dis - stroke rate close to 10%
what is Tx algorithm for symotomatic
NOT CONTROVERSIAL
- CEA for over 50% stenosis
- no benefit for under 50% - meds
what is Tx algorythm for asymmtomatic
CONTROVESIAL
- CEA for over 60% - modest benefit
- no benefit under 60
4 groups that have higher stroke rate in asymtomatic and should consider CEA
- men
- younger
- high grade contralateral lesion
- ulcerated or echolucent lesion
what to do for occluded
no risk because no blood flow
what is subclavian steal syndrome
block in sublavian
> need blood from vertebrate for R arm
> when use R arm get dizzy
Tx of steal syndrome
almost always benign
