Carotid Artery Disease Flashcards
Risk Factors for Carotid Artery Disease
HTN smoking diabetes TIA carotid stenosis cardiac disease (AFIB, endocarditis)
Amaurosis Fugax
transient monocular visual disturbance
abrupt onset, short duration
“a shade is descending”
Diagnosis of Carotid Artery Disease
carotid duplex ultrasound
Carotid Endarterectomy
goal is to prevent stroke!!!!
symptomatic patients have maximal benefit from carotid endarterectomy
North American Symptomatic Carotid Endarterectomy Trial (NASCET)
patients w/ symptomatic carotid stenosis randomized to medical vs surgical treatment
high grade stenosis (70-99%)–> surgery
high-moderate (50-69%)–> “gray zone”
low- moderate stenosis (<50%)–> medical therapy
Complete occlusion of internal carotid artery
PROTECTIVE against store and requires no treatment
Indications for Carotid endarterectomy
for pt w/ symptomatic carotid artery disease with stenosis greater than 70%
for lesser % if: ulceration of plaque
occlusion of contralateral carotid
pt has recurrent symptoms despite optimal medical care
if bilateral disease
treat highest degree of stenosis 1st
Operative Considerations of CAE
heart attack is #1 cause of death
Carotid Sheath contains
carotid artery
internal jugular vein
vagus nerve
Common facial vein
enters internal jugular at level of carotid bifurcation
Vagus nerve
runs posterior, lateral to common carotid
Hyperperfusion Syndrome
rare complication from restoration of internal carotid flow resulting in hyper perfusion to ipsilateral cerebral beds and leads to mild cerebral edema, petechial hemorrhage, intracerebral bleeding
***pt may complain of frontal headache on same side as CAE
Post-CAE blood pressure control
SBP <160 mmHg
**can use nitroprusside and nitroglycerine to bring down pressure
Hypotension
risk of cerebral ischemia and stroke
Hypertension
risk for hyperperfusion syndrome, bleeding from ateriotomy
Subclavian Steal Syndrome
stenosis of origin of subclavian artery causes vascular steal from vertebral arteries, resulting in retrograde flow
Plavix
Antiplatelet agent used to prevent/minimize risk of ischemic events
irreversible effect, must stop 5-7 days prior to surgery
70 mg PO every day
CAPRIE trial
Clopidogrel vs Aspirin trial
showed plavix had lower risk of recurrent ischemic events compared to those with aspirin
Pt develops bradycardia, hypotension after CAE
should get EKG to evaluate for AV block, ischemia
Clamping for CAE:
1st: Internal carotid
2nd common
3rd external
unclamping: 1. external, 2. common , 3. internal.
