Carotid artery disease Flashcards
Define the two types of diseases that can occur in carotid artery disease?
- Transient ischemia
- occlusion of the cerebral artery where symptoms last less than 24hours - Stroke
- rapid cerebral occluson where symptoms last more than 24hours
Which is the most common cause in aetiology and what does it involve?
List the other 2 factors too
Cerebral infarction (84%)
- AF
- Endocarditis
- Drug abuse
- MI
- Haemotological
Also includes:
primary intracerebral hemorrhage and subarachnoid hemorrhage
Give a rough list of the risk factors involved in aetiology
Obesity Age Smoking Diabetes FH Hypertension/lipidaemia Male
Very generally, what is the reasons in its pathophysiology?
Thrombi/Emboli
Haemorrage
Any occlusion
In pathophysiology, what is the relationship behind velocity and radius of vessel? Then state what happens to velocity when stenosis is <50%, 50-70% and 70-79% and 80-89%?
As radius decreases, velocity increases
Stenosis: <50% = <125cm/s 50-70%=>125cm/s 70-79%=>270cm/s 80/89%=>140cm EDV
What are the examinable clinical features?
Neurological - collateral symptoms like paralysis, viscuspatial neglect
Cardiac
Auscultate carotids
What imaging tools can be used in investigation?
CT = see vessels and whether there is a blockage
Carotid USS
What is the treatment general non-surgical involved?
Smoking caessation
Control of hypertension
Diabetic control
Drugs =
Statin and antiplatlet
Who does carotid endarterectomy benefit?
It benefits those with >70% stenosis
Explain the process for determining whether endarterectomy is undertaken for assymptomatic stenosis?
Patient with TIA or non-disabling stroke is candidate so undergoes carotid imaging within 1 week
Determine whether significant or not (sig if 70% according to ECST criteria or more narrowing) *NASCET says 50%
If NS with stable neurological and symtoms = best medical treatment
If S but stable neuro/symtoms = best medical treatment
If S + not stable = carotid endarterectomy and stenting
How could perioperative stroke occur?
Plaque rupture
Hypoperfusion
Virchows triad = raw intimal surface + thrombosis
What is the NNT for within 2 weeks,2-4,4-12 and longer 12weeks (time of surgery)?
within 2 weeks = 5
2 to 4weeks = 10
4 to 12weeks = 18
longer than 12weeks =125
What is the best time to get operated on after getting diagosed? (in terms of surgery postpone)
within 2 weeks/ASAP
Who is carotid surgery offered to particularly?
All those with symptomatic >70% stenosis EXCEPT those with occlusion too
Who is considered for surgery?
Male with 50-69% stenosis
asymptomatic stenosis >70% (anyone)
Is the surgery prophylactic?
YES!
form of surgery whose purpose is to minimize or prevent the risk of developing cancer in an organ or gland that has yet to develop cancer and is known to be at high risk of developing cancer.
