Carotid Disease

Question 1

MC preventable cause of ischemic stroke

Answer 1

atherosclerosis of the extracranial carotid arteries

Question 2

How is most carotid artery disease identified

Answer 2

bruit in the neck

Question 3

What is the risk of stroke in a patient who has experienced a TIA

Answer 3

25% in the first year

Question 4

When do most strokes occur after a TIA

Answer 4

weeks to months after

Question 5

What is the diagnostic modality of choice to dx carotid disease

Answer 5

Carotid duplex

Question 6

What is a CT or MRI used for in carotid disease

Answer 6

assess for cerebral infarction

Question 7

When is a carotid endarterectomy indicated

Answer 7

symptomatic disease (TIA or stroke), greater than 50% internal carotid stenosis), asx greater than 60% stenosis

Question 8

Do you operate on patients with totally occluded carotid ds

Answer 8

no

Question 9

What nerve lies in the carotid sheath

Answer 9

vagus

Question 10

Where is the vagus nerve located

Answer 10

between the jugular vein and carotid artery

Question 11

What nerve lies near the carotid bifurcation

Answer 11

hypoglossal nerve

Question 12

What artery lies near the carotid bifurcation

Answer 12

superior thyroid artery

Question 13

How should an arteriotomy during a CEA be closed

Answer 13

with a patch

Question 14

What is an eversion endarterectomy

Answer 14

the common and or external carotid arteries is removed, and the ICA is reanastomosed to the common carotid artery

Question 15

How long is blood pressure instability seen post op

Answer 15

usually 4-8 hours

Question 16

What is the treatment for post-op bleeding

Answer 16

reexploration

Question 17

Are wound infections common or uncommon after CEA

Answer 17

uncommon

Question 18

What is the most frequent complication after a CEA

Answer 18

cranial nerve injury

Question 19

What causes restenosis within the first 36 months

Answer 19

intimal hyperplasia

Question 20

What cells are seen in intimal hyperplasia

Answer 20

fibroblasts

Question 21

Name the 6 nerves commonly injured during CEA

Answer 21

hypoglossal, recurrent larygngeal, superior laryngeal, marginal mandibular, glossopharyngeal, spinal accessory

Question 22

What is the treatment for high risk patients with carotid disease

Answer 22

carotid stenting

Question 23

What is restenosis after 36months attributed to

Answer 23

progression of atherosclerotic disease

Question 24

What surveillance is done post-op

Answer 24

duplex US

Question 25

Early postop narrowing is usually attributed to

Answer 25

technical error

Question 26

What is the tx for technical error

Answer 26

take back to OR

Question 27

Asx patients with restenosis are treated when what % is stenosed

Answer 27

greater than 80%

Question 28

How are patients treated in the peri-op period

Answer 28

aspirin, beta-blocker, statin

Question 29

What nerve is mostly injured in re-op for recurrent carotid disease

Answer 29

glossopharyngeal nerve

Question 30

What is usually used for patch angioplasty

Answer 30

Dacron or saphenous vein

Question 31

All patients with a carotid stenosis prior to a stent should receive what medical therapy

Answer 31

aspirin, plavix or ticlopidine

Question 32

What are the risk factors associated with atherosclerosis

Answer 32

HTN, smoking and hyperlipidemia

Question 33

What neurologic issue are you worried about periprocedural during stenting

Answer 33

embolic stroke

Question 34

When should follow up occur after stent placement

Answer 34

2 weeks, 1 month, and a CTA at 6 months

Question 35

How are mycotic aneurysms treated

Answer 35

antibiotics

Question 36

What carotid backpressure correlates with adeqaute cerebral collateral perfusion

Answer 36

70mm Hg