Chapter 99 - Brachiocephalic artery disease - endovascular Flashcards

1
Q

Concomitant arch disease in patients with carotid bifurcation disease

A

5-15%

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2
Q

Most common arch vessel disease

A

Left subclavian

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3
Q

Rate of concurrent innominate and LCCA disease

A

30%

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4
Q

Percentage of LCCA from innominate artery

A

20%

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5
Q

Percentage of left vert from aortic arch directly

A

6%

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6
Q

Best angle to see innominate origin

A

20 degrees RAO

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7
Q

Best angle to see aortic arch

A

LAO

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8
Q

Unfavorable features to endo arch vessel disease

A

1) occlusion
2) eccentric lesions
3) vessel origin in ascending aorta
4) heavy calcification
5) ulceration
6) symptomatic
7) ostial lesion
8) plaque abutting vertebral artery origin

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9
Q

Angioplasty of arch vessel vs stent

A

Angioplasty + selective stent vs primary stent

patency the same, 89% 23 mth and long term 77-80%

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10
Q

DAPT vs DAPT + glycoprotein IIb/IIIa inhibitor in arch stenting

A

increases bleeding

DAPT only is better

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11
Q

Predilation balloon key points

A

1) 4-6 mm for arch vessel enough
2) length should be slightly bigger so the balloon won’t slip
3) diameter should be smaller so no dissection

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12
Q

amount of protrusion of stent into aorta

A

1-2 mm

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13
Q

Results of concurrent CEA and proximal CAS

A

30 day
stroke 1.5%
mortality 0.7%

only done if both hemodynamically significant

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14
Q

Arch stent patency 5 years

A

77-89%

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15
Q

AbuRahma endo vs open

A

complication similar
patency at 1, 3, 5 years
endo 93, 78, 70
open 100, 98, 96

other studies confirm

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16
Q

Arch inflammatory condition revascularization key points

A

1) wait till inflammation in quiescent
2) if must operate during inflammation then autogenous vein better

3) endo ok for short lesion
4) stent is better than POBA
5) autogenous bypass or transposition better