Cerebrovascular Interventions Flashcards
What is recommended as initial therapy for prevention of stroke in patients with stroke and transient ischemic attack?
Aspirin (50 to 325 mg/day) monotherapy, combination of aspirin and extended-release dipyridamole, and clopidogrel monotherapy
Class I, Level of Evidence A. (Adams RJ, et al. Stroke 2008;39(5):1647–1652)
Which combination therapy is recommended over aspirin alone based on the ESPRIT trial?
Combination of aspirin and extended-release dipyridamole
Class I, Level of Evidence B.
What did the MATCH trial conclude about dual antiplatelet therapy with aspirin and clopidogrel?
No additional clinical value of adding aspirin to clopidogrel in high-risk patients with TIA or ischemic stroke
Increased risk of life-threatening or major bleeding.
What is indicated for patients with symptomatic carotid artery stenosis?
High-intensity statin therapy
Simvastatin 40 mg/day is moderate in intensity.
What factors make carotid endarterectomy (CEA) technically challenging or not feasible?
Prior radiation to the neck, prior neck surgery, ipsilateral CEA, aorto-ostial or proximal common carotid disease
Higher risk in patients with restenosis following CEA, contralateral internal carotid artery occlusion, severe comorbidities, and contralateral laryngeal nerve palsy.
What are high-risk features for recurrent stroke in patients with TIA?
Hemispheric TIA, recent TIA, increasing frequency of TIA, high-grade carotid stenosis
Risk of stroke: 10% in the first year and about 30% in 5 years.
What is an absolute contraindication for carotid artery stenting and endarterectomy?
Presence of pedunculated thrombus
Anticoagulation should be initiated and reassessment with angiography postponed for at least 4 to 6 weeks.
What is the recommended embolic protection strategy during carotid revascularization?
Flow reversal (transcarotid arterial revascularization)
Comparison with other listed options.
Is the risk of recurrent stroke high in the acute phase after presenting symptoms?
True
Risk can be up to 7 days after presenting symptoms.
What is the next best step to treat intraprocedural hypotension?
Intravenous (IV) fluid resuscitation
What is the risk of stroke in patients with severe asymptomatic carotid artery disease who are at acceptable surgical risk?
3.2% per year
CEA remains the standard of care.
What complication is associated with carotid stenting and results from a large thrombus burden?
No-reflow
Aspirating the thrombus while the FilterWire is in place is the recommended strategy.
What does the CREST trial demonstrate about carotid artery stenting and CEA?
No significant difference in the risk of composite primary outcome of stroke, MI, or death
Higher risk of stroke with stenting and higher risk of MI with endarterectomy.
What is the normal peak systolic velocity (PSV) for the vertebral artery?
Approximately 20 to 60 cm/s
A focal PSV of >100 cm/s is indicative of significant stenosis.
What is the recommendation for routine screening for carotid artery stenosis in asymptomatic patients?
No guidelines to support routine screening, except prior to CABG
Screening recommended for specific high-risk groups.
