Carotid Artery Surgery - Presentation, Investigation & Therapy Flashcards
<p>What is often the cause oftransient ischaemic attacks and ischaemic stroke.?</p>
<p>Atherosclerosis of the carotid arteries</p>
<p>What is the definition of a TIA?</p>
<p>Focal CNS disturbance caused by vascular events such as microemboli and occlusion, leading to cerebral ischaemia. Symptoms last less than 24hours and there are no permanent neurological sequelae.</p>
<p>What is the definition of stroke?</p>
<p>Clinical syndrome consisting of rapidly developing clinical signs of focal or global disturbance of cerebral function, lasting more than 24hours or leading to death, with no apparent cause other than that of vascular origin.</p>
<p>What are the causes of stroke (TIA)</p>
<p>Cerebral infarction (84%)</p>
<p>Primary intracerebral haemorrhage (10%)</p>
<p>Subarachnoid haemorrhage (6%)</p>
<p>What are the causes of cerebral infarction?</p>
<p>AF</p>
<p>Carotid atherosclerotic plaque rupture/thrombus (15%)</p>
<p>Endocarditis</p>
<p>MI (clot arises from here)</p>
<p>Carotid artery trauma/dissection</p>
<p>Drug abuse</p>
<p>Haematological disorder e.g. sickle cell disease</p>
<p>What are the risk factors for carotid atherosclerosis?</p>
<p>Smoking</p>
<p>Diabetes</p>
<p>Family history</p>
<p>Male sex</p>
<p>Hypertension</p>
<p>Hyperlipidaemia/hypercholesterolaemia</p>
<p>Obesity</p>
<p>Age</p>
<p>NOT:DVT 2° to flight – venous disease is different from arterial disease</p>
<p>How is diagnosis of carotid artery atherosclerosis achieved?</p>
<p>History</p>
<p>Examination</p>
<p>CT</p>
<p>Carotid USS</p>
<p>How can you examine for athersclerotic carotid artery?</p>
<p>Cardiac</p>
<p>Auscultate carotids</p>
<p>Neurological: remember contralateral symptoms of <u>paralysis</u>, <u>paresis</u> (partial paralysis) /<u>visuospatial neglect</u>, <u>dysphasia</u> (deficiency in the generation of speech, and sometimes also in its comprehension, due to brain disease or damage.); ipsilateral amaurosis fugax symptoms (this is when the embolus is in the retinal artery – only circumstance it is ipsilateral)</p>
<p>How does the velocity of blood change as it passes through an occluded coaritf artery?</p>
<p>Velocity increases - diagnosis via carotid imaging is achieved this way</p>
<p>What is the best management for Stroke and TIA?</p>
<p>Smoking cessation</p>
<p>Control of hypertension</p>
<p>Antiplatelet (aspirin or clopidogrel)</p>
<p>Statin</p>
<p>Diabetic control</p>
<p>What is carotid endarterectomy?</p>
<p>Artery is clamped above and below the plaque</p>
<p>An incision is made to open the carotid artery</p>
<p>Plaque is removed</p>
<p>Repaired artery is closed</p>
<p>Can prevent stroke in the case of a severely narrowed carotid artery</p>
<p>What does the external carotid give supply to?</p>
<p>External gives supply to the thyroid, tongue and the facial artery.</p>
<p>Internal carries onto the next territory</p>
<p>What are the complications of an endarterectomy?</p>
<p>Wound infection</p>
<p>Bleeding</p>
<p>Scar</p>
<p>Anaesthetic risks</p>
<p>Nerve damage</p>
<p>Perioperative stroke:</p>
<p>- Plaque rupture</p>
<p>- Hypoperfusion (caused by clamping of the carotid)</p>
<p>Virchow’s triad – raw intimal surface and thrombosis – any change to the vessel wall can cause thrombus formation</p>
<p>What are the possible nerves that you may damage during a carotid endarterectomy?</p>
<p>Hypoglossal nerve which controls the tongue</p>
<p>Glossopharyngeal nerve</p>
<p>What is another means of reducing restriction of blood flow through the carotids?</p>
<p>Stenting</p>
