Carotid Artery Occlusive Disease Flashcards
What are the 10 major causes of Atherosclerosis?
- Genetics
- Tobacco abuse
- Hypertension
- Diabetes
- Hyperlipidemia
- Increased homocysteine levels
- lack of exercise
- diet and obesity
- female (estrogen increases risk of clotting & smaller arteries)
- job and environment
Why does tobacco use cause atherosclerosis?
- carbon monoxide
- arterial wall injury, increased plasma flux, entry of LDL, intimal hyperplasia (starts thickening, as its thickening it is getting stickier)
- increaed platelet reactivity
- lowers HDL levels
- peripheral vasoconstriction
Why does diabetes cause atherosclerosis?
- increaed lipoproteins
- inhibits basement membrane function
- growth factors come form basement membrane, inhibiting healing
- platelet aggregation
- cytokine-enhanced smooth muscle cell proliferation
- enhancement of thrombogenic factors II, V, and X
- so they are more likely to clot
What are the 8 suggestions to reduce atherosclerotic risk?
- Platelet Inhibitor
- Smoking cessation
- Control hypertension
- Control diabetes
- Decrease hyperlipidemia, LDL level, and triglycerides
- Diet
- Aerobic exercise
- Multivitamin
- Vitamin E and Vitamin C - antioxidants, increase vascular elasticity
- B-complex vitamins with B6, B12, and folic acid – decrease homocysteine levels
- omega 3 fish oil
How does coated aspirin provide medical management for atherosclerosis?
- Coated aspirin
- inhibits cyclooxygenase activity which block prostaglandin metabolism and synthesis of thromboxane A2 – stimulator of platelet aggregation
- mainly COX 1 (platelets), COX2 (inflammatory cells) 50:1
- inhibits cyclooxygenase activity which block prostaglandin metabolism and synthesis of thromboxane A2 – stimulator of platelet aggregation
How does Plavix provide medical management for atherosclerosis?
- Plavix
- block DP receptor P2Y12, and extra carboxymethyl side group
- 6 times more potent than Ticlid with fewer side effects
- CAPRIE trial (Clopidogrel vs Aspirin in Patients at Risk of Ischemic Events)
- 8.7% risk reduction in vascular death, ischemic strok, and myocardial infarction versus aspirin
When is surgery indicated for an asymptomatic patient?
when stenosis is 70% or greater
What percent of patients symptomatic with a TIA will have a stroke in 1 year for patients with 70% stenosis, 80% stenosis, and 90% stenosis?
- 70% stenosis
- 35% risk in 1 year
- 80% stenosis
- 46% risk in 1 year
- 62% risk in 2 years
- 90% stenosis
- 75% risk in 1 year
What is a TIA and what is the clinical presentation?
Transient Ischemic Attack
Block blood to the brain they symptom is related to what part of the brain is ischemic
It traditionally lasts less than 24 hours
What is the concern for prompt treatmetn of a patient who had a stroke? Why do not treat immediately?
- High likelyhood of a 2nd stroke with worsening deficits
- Periumbra region, “scar down period” to prevent an ischemic infarction to worsen/extend by way of hemorrhagic infarction during reperfusion
What is stroke in evolution?
“stuttering stroke”
on medication, but situations are geting worse, so it is a hard decision about whether to wait the 2 weeks to go to surgery
How is carotid artery disease diagnosed?
- physical exam, listening for bruits
- Imaging
- angiography
- ultrasound
- CTA
- MRA
What is the most commonly used technique to diagnose carotid disease?
Specificity adn Sensitivity respectively?
What information does it provide?
- Duplex ultrasound scanning
- 90% sensitivity and specificy with experienced operators
- percentage stenosis, residual lumen diameter, and plaque morphology– especially calcification
What are the advantages for performing a contrast study?
- Advantage
- cofirm doppler findings
- “roadmap” for surgery
- visualization of aortic arch, extracranial vessels (subclavian and vertebral arteries), and intracranial vessels
- Carotid cerebral angiography
- “gold standard”
- invasive
- most institutions forgo if non-invasive testing is of diagnostic quality
- Cat scan angiogrpahy
- MRA with gadolinium
What are the 6 general steps for carotid artery surgery?
- Shunt
- patch graft angioplast
- (makes body larger rather than longer, also platelets less likely to attach)
- anti-platelet drugs (aspirin for life)
- cranial nerve injury
- can injur the vagus, & hurt the vocal cords
- can injur hypoglossal, tonge will deviate to side of lesion
- can injur glossopharyngeal nerve, will pralalyze back 2/3 tongues – difficulty talking & swallowing and lose ability to tast
- can injur spinal accessory nerve, and you will have a loose scapula
- stroke, mortality
- the combined perioperative risk of death and stroke 3% in asymptomatic compared to 5% for symptomatic patients
- Post-operative follow-up
- dopplers 6 weeks, 6 months, 1 year, then annualy
What time frame does white thrombus indicate?
- white thrombus is at least 7 days old
- heme will be absorbed by the body & the clot will turn white
What are the benefits of carotid stenting?
What invention has improved safety of this procedure?
- Carotid stenting
- less invasive, percutaneous
- developed for patients at high risk for surgical intervention
- safety of procedure has improved with advent of embolic protection devices
The provided image is an example of what procedure?
carotid stenting
