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Vascular > Chapter 9: Carotid Intervention > Flashcards

Chapter 9: Carotid Intervention Flashcards

1
Q

a surgical incision through the wall of an artery into the lumen

A

arteriotomy

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2
Q

A catheter-based procedure in which a metal mesh tube is deployed into an artery to keep it open following balloon angioplasty to dilate a stenosis

A

carotid artery stenting

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3
Q

A surgical procedure during which the carotid artery is opened and plaque is removed in order to restore normal luminal diameter

A

carotid endarectomy

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4
Q

a narrowing of the lumen of a stent that causes a stenosis

A

in-stent restenosis

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5
Q

abbreviated PTFE, is a synthetic graft material used to create grafts and blood vessel patches; a common brand name is Gore-Tex

A

polytetrafluoroethylene

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6
Q

plaque observed at end of ECA site, may have abrupt stepped edge (shelf-lesion_; color and spectral Doppler may display turbulence or elevated PSV depending on severity

A

residual plaque

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7
Q

disruption along vessel wall with moving material observed within lumen; disturbed color flow patterns and elevated PSV often present

A

intimal flap

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8
Q

no color filling, no lumen detected, no spectral Doppler signal

A

occlusion

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9
Q

irregular buckling of patch material along vessel wall; perivascular fluid accumulation

A

infected patch

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10
Q

nonvascular mass adjacent to vessel; may appear cystic or contain various levels of echogenicity

A

hematoma

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11
Q

dilated area attached to vessel with flow demonstrated on color and spectral Doppler; to and fro pattern flow may be detected in connection between dilated sac and native vessel; color swirling (yin-yang appearance_ present within dilated sac

A

pseudoaneurysm

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12
Q

focal area of elevated velocities with poststenotic turbulence; homogeneous material present along the wall in cases of restenosis due to hyperplasia

A

restensosis

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13
Q

open operation that is performed through an arteriotomy mode longitudinally from normal ICA, through the bulb, and into CCA

A

Carotid edarectomy

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14
Q

common potential problems of carotid endarectomy

A

narrowing as a result of closure
plaque retained from an incomplete excision
neointimal hyperplastic response to the months of follow-up

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15
Q

Patches may be either _____ or ____.

A

autogeneous vein
synthetic

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16
Q

complete transection of ICA at carotid bifurcation; does not require a patch because sutures are placed on widened bulb of ICA

A

eversion carotid endarectomy

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17
Q

Post CAS patients should have an exam done at least ____ or less for baseline study.

A

1 month

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18
Q

patch that has woven appearance to walls

A

Dacron patch

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19
Q

patch that shows as two brightly echogenic lines

A

double layered PTFE

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20
Q

Snythetic patch and swelling typically lie _____ to endarectomy.

A

superficial

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21
Q

may be the result of blood extravasated from surrounding tissue or loose ligatures

A

hematoma

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22
Q

nonstenotic vascular problem that gives vessel aneurysmal appearance

A

oversized or irregular patch

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23
Q

Patch identified as synthetic is more ______ than an autogeneous patch

A

thrombogenic

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24
Q

stenosis identified within first postoperative month are considered:

A

technical problems of surgery

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25
Q

cut edge of plaque is left and creates an abrupt stepped edge in arterial wall

A

shelf-lesion

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26
Q

A shelf-lesion is more commonly associated with the ____ edge of CEA.

A

distal

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27
Q

Post CAS risk factors for restenosis

A

active smokers
women
patients who undergo CEA at a young age
patients with hypertension
hypercholestrolemia
diabetes

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28
Q

technical factors leading to restenosis

A

clamp injury
use of an intraluminal shunt
placement of tacking sutures at distal end point of endarectomy site

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29
Q

narrowing over first 24 months; considered relatively benign with the low thromboembolic potential of fibrotic plaque

A

neointimal hyperplasia

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30
Q

restenosis after 2 years

A

progressive atherosclerostic plaque

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31
Q

Moderate (>50% %) restenosis increased risk for _____.

A

ipsilateral stroke

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32
Q

Restenosis following CAS is inversely associated with _____.

A

stent diameter

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33
Q

Restenosis following CAS is positively associated with _____.

A

stent length

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34
Q

Majority of restenosis patients occur in the first ____

A

18 months

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35
Q

biomechanical forces of stent fracture/deformation

A

head tilting
neck rotations
swallowing

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36
Q

border of stent may appear to protrude into lumen wall

A

stent deformation

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37
Q

produce an abrupt edge within stented portion with associated changes in color-flow signals

A

stent fracture

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38
Q

Where does a typical carotid endarectomy procedure involvinga longitudinal arteriotomy begin and end?

A

a normal distal portion of ICA into the CCA

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39
Q

Which of the following is NOT a common problem leading to stenosis at the level of the arteriotomy performed during endarterectomy?
a. use of a patch
b. narrowing due to sutures
c. retained plaque
d. hyperplastic response

A

a

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40
Q

Why does the eversion technique for carotid endarterectomy not require a patch?

A

the sutures are at the widened area of the bulb

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41
Q

When evaluating an adarterectomy site within 48 hours of the surgical procedure, one should be mindful of preventing infection by using all of the following EXCEPT:
a. using sterile gel
b. leaving the sterile dressing in place
c. using sterile pads
d. using sterile transducer cover

A

b

42
Q

Because of limitations in evaluating the vessels following an endarterectomy, what becomes more important to evaluate?

A

quality of flow in the distal ICA

43
Q

Which malformation may be associated with neck swelling post-CEA?
a. pseudoaneurysm
b. hematoma
c. infection
d. all of the above

A

d

44
Q

What does a perivascular fluid collection above the irregular buckling of a patch indicate?

A

active infection

45
Q

What is stenosis at the CEA site usually considered to result from more than 24 months after an endarterectomy?

A

neointimal hyperplasia

46
Q

During duplex evaluation of a patient post-CEA, residual plaque is noted at the distal end of the surgical site, creating an abrupt edge of teh arterial wall. What is this defect commonly called?

A

shelf lesion

47
Q

When might the velocity criteria established for native (nonoperated) carotid arteries NOT be valid in post-CEA ICA?

A

native criteria are not used after any CEA procedure

48
Q

Which artery is most often used for catheter insertion for CAS?

A

the common femoral artery

49
Q

What is the guidewire used for CAS usually first used to deploy and position?

A

the embolic protection device

50
Q

Stent distortion has been reported with mechanical forces on the neck from all of the following EXCEPT:
a. head tilting
b. coughing
c. neck rotations
d. swallowing

A

b

51
Q

For maximum efficacy, how far should a stent extend proximal and distal to the lesion?

A

a few millimeters

52
Q

During a duplex examination post-CAS, the stent is noted to have an irregular border with an abrupt edge. Turbulence is noted with color and spectral Doppler. What do these findings suggest?

A

stent fracture

53
Q

Which statement is true of postprocedural elevation of velocities in CAS?
a. it is always a sign of restenosis
b. it is not as frequent as in CEA
c. It is not necessarily a sign of restenosis
d. it is the result of great compliance of the stent

A

c

54
Q

How is flow maintained to the ECA when a stent has been deployed from the CCA through the ICA?

A

flow through the stent interstices

55
Q

During duplex assessment of a carotid artery stent, velocities at the distal end of the stent reach 350 cm/s. Turbulence is noted distal to this area. What do these findings suggest?

A

> 80% in-stent stenosis

56
Q

When surveilling an ICA stent, when do the majority of >50% stenoses occur?

A

within 18 months

57
Q

Which of the following can cause difficulties with carotid artery stents, such as restriction of balloon expansion, inadequate stent expansion, and increased risk of stent fracture?
a. smooth, homogeneous plaque
b. tortuous carotid artery anatomy
c. calcified plaque
d. intraluminal thrombus

A

c

58
Q

True restenosis of carotid endarterectomy within the first few months after surgery is due to ____.

A

technical difficulties

59
Q

The solution most often used to reduce the potential for procedure-induced stenosis with carotid endarterectomy involves the suturing of a _____.

A

patch

60
Q

Most problems arising after a CAE will often be everted such as to provide a double layer of vessel wall, with the _____ of the vein facing the lumen of the artery.

A

intima

61
Q

The eversion technique for endarterectomy involves a complete _____ of the ICA and ECA at the level of the carotid bulb.

A

transection

62
Q

It is not unusual to find entrapped air directly above the CEA site. In such case, the sonographer could image the vessels using a more _____ approach.

A

posterior

63
Q

The patch and swelling associated with CEA typically lies ______ to the endarterectomy.

A

superficial

64
Q

If a pseudoaneurysm is visualized after CEA, the most likely source for this pathology would be ______.

A

suture disruption

65
Q

A potential complication with a synthetic patch is that they are more ______ than a vein patch, especially when the synthetic patch is aneurysmal.

A

thrombogenic

66
Q

The conclusion of a recent study regarding velocities of the normal ICA distal to CEA patching was that these velocities were _____ than those of nonoperated ICAs.

A

higher

67
Q

Postprocedural complications of CAS are not limited to the carotid vessels but can also be seen in the ______ artery because it is often a path for the catheter.

A

common femoral

68
Q

Even though stent material is highly reflective, it does not produce ______ that may limit visualization of the stent.

A

shadowing

69
Q

a stent should be imaged in multiple planes, ensuring that the _____ of the stent to the surrounding plaque is complete.

A

apposition

70
Q

The protrusion of the stent into the vessel lumen, together with a reduced flow channel through stent on color Doppler, indicates stent ______.

A

deformation

71
Q

The single greatest concern of postent evaluation is ____.

A

restenosis

72
Q

Increased manipulation of the catheter at the level of a calcified plaque may increase the ______ response and lead to restenosis.

A

hyperplastic

73
Q

When using flow-velocity criteria, the primary discriminator of significant restenosis in CAS is _____.

A

PSV

74
Q

A high-grade restenosis seen in CAS should correlate with a PSV of ____.

A

300-350

75
Q

Dense circumferential calcification is of particular concern with CAS because it _____ balloon expansion.

A

constricts

76
Q

Reintervention for either CEA or CAS would be warranted if the treated lesion leads to _____.

A

symptoms

77
Q

Arteriotomy is made through _____.

A

internal carotid artery

78
Q

2 types of surgical patches

A

autogenous vein
synthetic material

79
Q

ICA is transected at the bifurcation; ICA is everted and plaque is peeled from arterial wall

A

eversion

80
Q

_____ has a woven appearance.

A

Dacron patch

81
Q

______ has two brightly echogenic lines.

A

polytetrafluoroethylene

82
Q

Remnant plaque is also known as

A

“shelf lesion”

83
Q

Complications of stenting:

A

dissection
thrombosis
perforations

84
Q

Atherosclerotic plaque is not removed in ____.

A

CAS

85
Q

border of stent protruding into lumen
abrupt edge within stented portion
changes in color flow associated with these findings

A

Stent fraction and migration

86
Q

Primary discriminator for significant stenosis is ___.

A

PSV

87
Q

With carotid endarterectomy (CEA), common problems that may occur at the distal point of the arteriotomy include all of the following except:
a. a stenosis due to neointimal hyperplasia
b. a stenosis due to retained plaque
c. A stenosis as a result of narrowing due to the suture closure
d. A stenosis as a result of injury due to an embolic protection device

A

d

88
Q

Which of the following is not considered a technical error associated with CEA?
a. an intimal flap
b. narrowing due to suture closure
c. retained residual plaque
d. neointimal hyperplasia

A

d

89
Q

Patches used during CEA are commonly all of the following materials except:
a. autogeneous vein
b. PTFE
c. Dacron
d. Autogeneous artery

A

d

90
Q

Patients with neck swelling ipsilateral to a CEA are most likely to have all of the following except:
a. a hematoma
b. an arteriovenous fistula
c. an infection
d. a pseudoaneurysm

A

b

91
Q

Which of the following techniques may provide the best assistance in proper visualization of the carotid bifurcation in the early postoperative period?
a. using power Doppler
b. Using a very anteromedial approach
c. Using fundamental imaging in place of harmonic imaging
d. Using a posterior approach

A

d

92
Q

Which of the following is most likely to be observed on ultrasound within a dilated synthetic patch?
a. intimal flaps
b. laminated thrombus
c. calcification
d. rupture of the fabric of the patch

A

b

93
Q

An intimal flap can display all of the following on ultrasound except:
a. disturbed color flow patterns
b. A short piece of material protruding into the vessel lumen
c. color flow within two separate flow channels
d. elevated velocities

A

c

94
Q

On ultrasound, a shelf lesion associated with a CEA will appear as:

A

an abrupt, stepped edge in the arterial wall, usually at the proximal or distal edges of the endarterectomy

95
Q

When examining a carotid stent with ultrasound, which of these areas is the most common for a stenosis?
a. the stent border
b. the distal ICA beyond the stent
c. the mid-stent
d. the proximal CCA

A

a

96
Q

When performing an ultrasound of a carotid stent the B-mode image should be carefully examined for all of the following except:
a. hyperplastic cell growth
b. stent deformation
c. shelf lesions
d. incomplete deployment

A

c

97
Q

In-stent restenosis is typically described as:

A

homogeneous and hypoechoic

98
Q

Which of the following statements correctly describes abnormalities seen within the first month following the placement of a carotid stent?
a. a stenosis is likely due to uncontrolled risk factor, such as diabetes or hypercholesterolemia
b. a stenosis is likely due to a hyperplastic lesion
c. A stenosis is likely due to a progression of atherosclerotic disease
d. A stenosis is likely due to a technical problem associated with stent deployment

A

d

99
Q

According to the data presented in this chapter, this type of restenosis was most predictive of the need for reintervention.

A

diffuse proliferative restenosis

100
Q

Which statement best describes the changes in velocity criteria for in-stent restenosis?
a. elevate the PSV used to determine 70% or greater stenoses
b. Elevate the ICA/CCA ratios used to determine 70% or greater stenoses
c. elevate the PSV and EDV used for 50% stenosis thresholds
d. elevate all velocity thresholds

A

d

101
Q

Which statement best describes the current ultrasound surveillance schedule for carotid stents?
a. follow up every 6 months for the first 18 months, with additional follow up at 6 to 12 month intervals depending on velocities recorded
b. follow up every 6 months for the first 18 months then no further follow up if asymptomatic
c. Follow up every 6 months for life, for all patients regardless of velocities or symptoms
d. One ultrasound a month, then once a year thereafter

A

a

102
Q
A

Vascular (33 decks)

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