Brainscape's Knowledge GenomeTM

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


See full index

Vascular > Carotid Disease > Flashcards

Carotid Disease Flashcards

1
Q

Definition of stroke

A

Focal neurological deficit lasting >24 hours as result of disease process of vascular origin

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

Definition of TIA

A

Focal neurological deficit lasting <24 hours

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

Percentage of stroke that are

1) Ischemic
2) Hemorrhagic

A

1) 80%
2) 20%

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

Percentage of ischemic stroke due to

1) thromboembolic of ICA/Middle cerebral artery
2) Small vessel disease
3) Cardiogenic brain embolism
4) Hematological
5) Other causes

A

1) 50%
2) 25%
3) 15%
4) 5%
5) 5%

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

Causes of ischemic stroke

A

Thromboembolism of ICA/MCA
Small vessels disease
Cardioembolic brain embolism (post MI, AF, vegetation)
Hematological
Others: FMH, arteritis, carotid dissection, carotid tumor, vasculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non-atheromatous carotid diseases

A

Fibromuscular hyperplasia
Takayasu arteritis
Giant cell arteritis
Carotid aneurysm
Carotid dissection
Carotid body tumor

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

Carotid body

1) Location
2) Function

A

1) located within the adventitia of posterior aspect of carotid bifurcation
2) monitor blood gas and pH

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

Carotid body tumour

1) Pathological origin
2) Percentage malignant
3) Percentage bilateral

A

1) neural crest ectoderm
2) 5%
3) 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical presentation of carotid body tumour

A

Pulsatile neck mass
Local compression:
-Hoarseness of voice (RLN)
-Horner’s syndrome
-CN palsies
Hormonal mediated:
-Flushing
-Dizziness
-Hypertension
-Arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lyre’s sign

A

Carotid splaying
Widening of the carotid bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

DDX for carotid body tumor

A

Glomus vagale
Glomus jugular tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cranial nerves at risk in management of carotid body tumour

A

Glossopharyngeal
Vagus
Accessory
Hypoglossal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Classic carotid territory symptoms

A

1) Hemimotor/ sensory signs
2) Transient monocular blindeness
3) Higher cortical dysfunction (dysphasia, visuospatial neglect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Classic vertebrobasilar territory symptoms

A

Bilateral blindness
Problems with gait and stance
Hemi- or bilateral motor/sensory signs Dysarthria
Homonymous hemianopia
Diplopia, vertigo and nystagmus (provided it is not the only symptom)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ABCD2 score

A

Predicts 7-day risk of stroke after TIA

Age >60
SBP >140, DBP >90
Clinical features (unilateral weakness, speech disturbance)
Duration of symptoms
Diabetes

0-3 low risk
4-7 high risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Total anterior circulation infarct (TACI)

A

Hemisensory/motor deficit
Higher cortical dysfunction
Homonymous hemianopia

17
Q

Posterior circulation infarct

A

Vertebrobasilar infarct

Bilateral blindenss
Gait and stance
Nystagmus
Diplopia
Vertigo
Dysarthria

18
Q

Management of symptomatic carotid stenosis

A

Medical treatment
Screen for reversible factors:
-Transcranial color DopplerL: intracerebral arteries
-Duplex USG of neck: carotid arteries
-DSA (gold standard)
Carotid endarterectomy vs endovascular stenting

19
Q

Evidence in carotid endarterectomy vs medical treatment

A

ECST (European Carotid Surgery Trial)

NASCET (North American Symptomatic Carotid Endarterectomy Trial)

Conclusion: surgery decreases risk fo stroke significantly in pt with history of TIA/non-disabling stroke in recent 6 months

20
Q

Evidence for surgical intervention in asymptomatic carotid stenosis

A

ACAS, ACST: small but significant decrease in stroke risk
Cochrane meta analysis: does not recommend routine surgery

21
Q

Evidence of CEA vs stenting

A

Controversial
2005 Cochrane meta-analysis
EVA 2006
SPACE
3 other RCTs ended prematurely

22
Q

Timing for CEA

1) Immediate
2) Urgent (< 24 hours)
3) Early (within 2 weeks)

A
  • Immediate CEA: Thrombosis secondary to CEA, angiography or angioplasty
  • Urgent CEA: Evolving stroke, Crescendo TIA, stuttering hemiplegia particular if an unstable plaque demonstrated
  • Early CEA recommended: within 2-4/52 to reduce 20% risk of recurrent stroke within 6 weeks
23
Q

Criteria for CEA

A

Symptomatic moderate to severe carotid stenosis should meet the following conditions:

● An ipsilateral TIA or nondisabling ischemic stroke as the symptomatic event

● A surgically accessible carotid artery lesion

● A life expectancy of at least five years

● No prior ipsilateral endarterectomy

● No contraindications to revascularization

24
Q

Subgroups that would benefit from CEA

A

Men >50% stenosis
Men and women 70-99% stenosis

25
Q

Criteria for carotid artery stenting (CAS)

A

select patients with recently symptomatic carotid stenosis of 50 to 99 percent who have any of the following conditions:

●A carotid lesion that is not suitable for surgical access

●Radiation-induced stenosis

●Restenosis after endarterectomy

●Clinically significant cardiac, pulmonary, or other disease that greatly increases the risk of anesthesia and surgery

●Unfavorable neck anatomy including contralateral vocal cord paralysis, open tracheostomy, or prior radical surgery

26
Q

Carotid Endarterectomy procedure

A

Procedure

  • Supine, head resting on donut
  • Neck extended and head turned to opposite side
  • Oblique incision anterior to sternocleidomastoid muscle (mastoid to mid-clavicle)
  • Deepened to exposed CCA, ICA & ECA
  • Protect hypoglossal and vagus nerves
  • Arteries slinged and after heparinisation (systemic 5000 units), clamp with soft clamp
  • Longitudinal arteriotomy from CCA across stenosis to ICA
  • Plaques raised with dissector from CCA to ICA and proximal end cut with microscissors.
  • Proximal end tacked with prolene sutures
  • Arteriotomy closed with patch angioplasty
27
Q

Patch angioplasty vs primary closure in CEA

A

Patch closure (vein / PTFE / Dacron)

Evidence (systemic review):

  • decrease frequency of stenosis
  • lower rate of ipsilateral stroke
28
Q

CAS technique

A
  • LA with sedation
  • unfractionated heparin 5000-7500units
  • percutaneous femoral arterial access
  • Atropine delivered either via the sheath or intrave- nously to block the carotid sinus baroreceptors
  • Cross stenosis with distal embolic protection device
  • Stent delivered across stenosis
  • Dilation of stent for adequate apposition against arterial wall
  • Angiography performed in at least two planes
29
Q

Shamblin Staging

1) Type 1
2) Type 2
3) Type 3

A

1) tumors localized and easily resectable
2) tumor adherent or partially surrounding vessel
3) tumor intimately surrounding or encasing vessels

30
Q

Management of carotid body tumor

A

Surgery (main stay treatment for young good fit patient) +/- preop embolization +/- preop ECA stenting

RT

Embolization

Vascular (6 decks)

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