Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4: Vascular Surgery > Carotid artery disease > Flashcards

Carotid artery disease Flashcards

1
Q

What diseases affect the carotids?

A
  • Primary
    • Atherosclerosis
  • Secondary -due to kinking from:
    • Arterial elongation
    • Fibromuscular dysplasia
    • Radiation induced changes
    • Extrinsic compression (neoplasm)
    • Arteriopathies (temporal arteritis, Takayasus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Histologic features of atherosclerotic plaques?

A
  • Plaques form in intima and media
  • Smooth muscle cells are recruited
    • LDL cholesterol, monocytes and platelets are incorporated
  • Mature plaque has lipid core and fibrotic cap
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is carotid artery disease classified?

A

Radiologically by the degreee of stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical sequelae of atherosclerotic disease?

A
  • Thrombosis and embolisation
    • Enzymes degrade fibrous cap exposing lipid core
    • Core is highly thrombogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common symptoms of carotid artery disease?

A
  • TIA
  • CVA
  • Amaurosis fugax
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a TIA?

A

Neurologic deficit lasting <24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a CVA / stroke?

A

Neurologic deficit lasting >24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe Amaurosis fugax?

A
  • Episode of transient monocular blindness
    • (window shade being pulled across the eye)
  • Due to acute decrease in blood flow through opthalmic artery to the retina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are Hollenhorst plaques?

A
  • Cholesterol plaques in the retinal vessels
  • Seen at branch points
  • Due to arterial to arterial emboli
    • Most commonly from a carotid bifurcation plaque
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the use of medication on TIA and stroke?

A
  • Antithrombotics (aspirin/clopidogrel/dipyridamole)
    • Dual therapy used following TIA
  • Statins
  • Antihypertensives
    • Aim for <140 and <90
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe a carotid bruit?

A
  • Marker for atherosclerosis
  • Indicates risk of cardiac and cerebrovascular events
  • Higher degree of stenosis -> higher pitch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Preliminary tests to evaluate a carotid bruit or suspected TIA/CVA?

A
  • Duplex US
  • CT angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Should a patient with asymptomatic stenosis undergo surgery?

A
  • RCT: Carotid endarectomy (CEA) + aspirin vs. aspirin alone
  • Consider surgery if:
    • Patient expected to live 3 years
    • Low risk of cardiac event
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Differentials for carotid artery disease?

A
  • Vasculitis
  • Carotid dissection
    • Young patients with connective tissue disease/trauma/sudden movement
  • Fibromuscular dysplasia
    • Young females presenting with focal neuro deficit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the use of carotid artery stenting (CAS) vs CEA?

A
  • Stroke risk higher in perioperative period for CAS
  • CEA has a higher risk of MI
  • Outcomes for CAS worse in elderly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What cranial nerves can be damaged during CEA and what would this result in?

A
  • Marginal mandibular branch of CN VII:
    • Droop of ipsilateral corner of mouth
  • CN IX:
    • Difficulty swallowing
  • RLN of CN X:
    • Hoarseness, loss of effective cough
  • CN XII:
    • Deviation of tongue toward ipsilateral side
17
Q

Describe when neurological events could occur when performing CEA?

A
  • Dissection => Embolization of material from arterial wall
  • Clamping => Ischaemic infarct
  • Post-op => Reperfusion
18
Q

Describe the use of a shunt in CEA?

A
  • Plastic tube which loops around the surgical field
    • Provides blood flow during procedure
  • Used to avoid intraoperative ischaemia
19
Q

Describe methods of intraoperative assessment during CEA?

A
  1. Neurological status in an awake patient (LA or block)
  2. Electroencephalogram
  3. Stump pressure
20
Q

What is stump pressure?

A
  • Estimates brain blood flow by measuring pressure distal to the clamp
  • Mean pressure should be at least 40 mmHg
  • Determines need for a shunt during CEA
21
Q

Describe the risk of resteonsis following surgery?

A
  • Similar long term risk of restenosis in CEA and CAS
  • 10yr risk is between 8 and 12%
  • First 24 hrs post-surgery: Stenosis due to myointimal hyperplasia
  • Beyond this time: Stenosis due to disease progression (atherosclerosis)
22
Q

Treatment for restenosis after endarterectomy?

A
  • CN injury risk is higher with redo CEA
  • Stenting is preferred treatment modality
23
Q

In which layer of the artery is CEA performed?

A

Outer layers of the tunica media

24
Q

When the internal carotid artery is occluded, which branches of the external carotid artery form collaterals and reeestablish circulation in the circle of willis?

A
  • Periorbital branches of the ECA
  • Communicates with
  • Opthalmic branches of the ICA
25
Q

Describe both the carotid sinus and carotid body?

A
  • Both located at carotid bifurcation
  • Innervated by CN IX and X
26
Q

Function of the carotid sinus?

A
  • Regulates BP
  • Hypertension stimulates efferent impulses to the vasomotor centre in the medulla
  • Inhibits sympathetic tone and increases vagal tone
27
Q

Function of the carotid body?

A
  • Regulates respiratory drive and acid-base status
    • Via chemoreceptors
  • Induces bradycardia when manipulated (target for carotid massage)
28
Q

When is surgical intervention strongly indicated in carotid artery disease?

A

Symptomatic disease with >70% stenosis

29
Q

Major risk when performing carotid endarectomy?

A

5% risk of stroke

30
Q
A

Y4: Vascular Surgery (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions