Ex2 CVA

Question 1

Statistics

Answer 1

Leading cause of disability
3rd leading cause of death
TIA - 10x greater risk of having stroke

Question 2

Where is carotid stenosis most common

Answer 2

Bifurcation of internal + external arteries

Question 3

Why is carotid stenosis most common at specific location?

Answer 3

Turbulent Flow

Question 4

Blood supply to brain

Answer 4

20% of CO

Question 5

blood supply to brain is transported via

Answer 5

two pairs of blood vessels:

1. internal carotid arteries
2. vertebral arteries

Question 6

Two pairs of blood vessels that supply brain join to form

Answer 6

major intracranial blood vessels:

1. anterior cerebral arteries
2. middle cerebral arteries
3. posterior cerebral arteries

Question 7

tPa can be given

Answer 7

within 4h of onset of stroke

Question 8

amaurosis fugax

Answer 8

painless, temporary vision in one or both eyes

Question 9

symptoms of carotid artery stenosis

Answer 9

TIA

amaurosis fugax

Question 10

asymptomatic carotid stenosis

Answer 10

medical management

Question 11

medical management of asymptomatic carotid artery stenosis

Answer 11

smoking cessation 
antiplatelet therapy
BP CONTROL
lifestyle changes 
lipid lowering-strategies

Question 12

CEA - major risk

Answer 12

MI/ischemic heart disease

Question 13

Main goals for CEA - anesthesia

Answer 13

1. maintain HD stability

2. prompt emergence: immediate assessment of neuro status

Question 14

anesthesia management - CEA

Answer 14

GA: pre/post neuro assessment (quick on/off gas)
regional: advantageous to monitor neuro thru-out procedure

Question 15

important aspect of neuro monitoring for CEA

Answer 15

SAME anesthesia provider pre-post

Question 16

Sedatives - CEA

Answer 16

Barbiturates/Propofol - cerebral protection (dec. CMRO2)

-GA does NOT protect from vagal response to carotid sinus stimulation

Question 17

BP - CEA during surgery

Answer 17

HTN may help with circulation during clamp
(if becomes hypoTN d/t vagal: tx phenyl)
After Xclamp removed: treat HTN w/ NTG or SNP

Question 18

Most common complication: CEA

Answer 18

hematoma
-must know ASAP: potential compression of airway
Others: MI, nerve injury