Carotid Disease

Question 1

What is the duplex criteria for a significant carotid stenosis?

Answer 1

50-69%
PSV > 125 ICA/CCA > 2

> 70%
PSV > 230 ICA/CCA > 4

Question 2

Give 5 indications for CTA for carotid evaluation

Answer 2

Heavy calcification (shadowing)

High bifurcation

High resistance ICA (outflow lesion?)

Dampened CCA waveform (inflow lesion?)

CAS planning

Question 3

How can you improve distal operative exposure (5 techniques)?

Answer 3

Nasotracheal intubation

Extend incision behind ear

Divide ansa, post belly digastric, occipital artery, ascending pharyngeal artery

Divide SCM from mastoid, elevate/resect parotid

Remove styloid process

Sublux mandible

Question 4

If a patient is scheduled for CABG and carotid stenosis found, what would you do?

Answer 4

Symptomatic only, CEA first

Combined w CABG for 3 vessel disease and left main.

Question 5

What are some complications of shunting?

Answer 5

Dissection, vasospasm

Question 6

When are patients at high risk of hyper perfusion syndrome?

Answer 6

Severe Contralateral stenosis/occlusion

Question 7

What are the contraindications to CEA following acute stroke?

Answer 7

Significant neuro deficit without recovery

Cerebral hemorrhage

> 30% hemispheric stroke

Chronic ICA occlusion

ICA stenosis < 50^

Question 8

What percentage of strokes are due to ICA disease?

Answer 8

Up to 40%

Question 9

What are 8 indications for carotid stenting?

Answer 9

CHF (class 3 or 4), LVEF <30%,recent MI, unstable angina, high bifurcation, irradiated neck, previous CEA, contralateral occlusion.

Question 10

What are 4 contraindications for carotid artery stenting?

Answer 10

Contraindications to anticoagulant or antiplatelet, age > 80, shaggy aorta (thrombus), eggshell aorta (severe calcification).