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Summer 2014 - Intro to Vascular ✔️ > Extracranial Cerebrovascular Evaluation > Flashcards

Extracranial Cerebrovascular Evaluation Flashcards

0
Q

spectrum analysis sorts out the _____ _____ - FFT

A

Doppler frequencies

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1
Q

describe blood flow through spectrum analysis

A 
pulsatile
flow is slower at the periphery
vessels are not straight
vessels are not uniform
distorted by pathology
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2
Q

_____ _____ graphs the Doppler frequencies by moving blood

A

Doppler Spectrum

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3
Q

Doppler angle of _____ degrees or less is required for accurate frequency and velocity information

A

60 degrees

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4
Q

_____ _____ needs to be correctly positioned for Doppler Spectrum

A

sample volume

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5
Q

examples of broad systolic peak and forward flow throughout distole

A

CCA, ICA, vertebral, renal, celiac

low peripheral resistance
entire waveform above or below baseline

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6
Q

examples of tall, narrow sharp systolic peaks, reversed or absent flow through diastole

A

extremity arteries, ECA, SMA (fasting)

high peripheral resistance

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7
Q

pulsatility varies depending on _____

A

location

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8
Q

what alters pulsatility

A

physiology and pathology

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9
Q

pulsatility shows status of _____ function

A

cardiac

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10
Q

what is acceleration

A

flow velocity accelerates rapidly in systole

severe arterial obstruction, flow acceleration may be slowed

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11
Q

the greater the energy difference (gradient) the ______ the flow

A

greater

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12
Q

movement goes from _____ pressure to _____ pressure

A

high to low

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13
Q

describe disturbed flow

A 
less orderly
widening of the waveform
vascular disease
normal tortuous vessels
prominent area -- bulb
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14
Q

arterial obstruction description

A 
increased velocity
disturbed flow post stenotic
prox pulsatility changes
distal pulsatility changes
indirect effects - collateralization
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15
Q

Poiseuille’s Law formula

A 
Q = volume flow
R = vessel radius - most important b/c its to the 4th power
L = length of the vessel
N = viscosity
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16
Q

Poiseuille’s Law: the velocity of the steady flow of a fluid through a narrow tube varies ______ as the pressure and the 4th power of the radius of the tube and _____ as the length of the tube and the coefficient of viscosity

A

directly

inversely

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17
Q

Poiseuille’s Law: volume flow is _____ to the 4th power of the radius, even small changes in radius can result in _____ changes in flow

A

proportional

large

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18
Q

Poiseuille’s Law:

if pressure difference increases, flow rate _____
if diameter increases, flow rate _____
if length increases, flow rate _____
if viscosity increases, flow rate _____

A

increases
increases
decreases
decreases

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19
Q

Bernoulli’s Priciple

stenotic segment - pressure decreases, velocity _____
prox to a stenosis - pressure ______
distal to a stenosis - pressure _____

A

increases
increases
increases

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20
Q

flow moves along the path of least ______

A

resistance

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21
Q

_____ _____ _____ is a hallmark of high resistance vascular beds

A

diastolic flow reversal

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22
Q

_____ relationships are important as you evaluate arteries with US and Doppler

A

flow

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23
Q

______ or ______ is a interruption of blood flow to the brain

A

ischemic stroke or brain attack - 80%

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24
Q

_____ _____ ruptured intracranial blood vessel

A

intracranial hemorrhage - 20%

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25
Q

_____ _____ _____ disease is responsible for more than 50% of all stroke

A

extracranial carotid artery disease

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26
Q

_____ are the 3rd leading cause of death in the USA

A

strokes

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27
Q

what is the reasoning for scanning the carotid

A

to detect potential causes of stroke

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28
Q

what is a stroke or CVA

A

PERMANENT ischemic deficit

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29
Q

what is TIA

A

Transient ischemic neurologic deficit

resolves in < 24 hrs (1-30 mins)

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30
Q

what is RIND

A

reversible ischemic neurologic deficit

resolves in > 24 hrs (up to 3 weeks)

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31
Q

brain depends on the vascular system so even _____ episodes of interrupted cerebral blow can cause symptoms and cellular death

A

short

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32
Q

_____ remains the best treatment for stroke

A

prevention - take care of yourself (exercise, diet, etc)

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33
Q

what is a thrombotic stroke

A

clot in artery in the brain

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34
Q

what is an embolic stroke

A

piece of a clot is carried to the brain

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35
Q

what is a hemorrhagic stroke

A

blood vessel in the brain breaks

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36
Q

non modifiable risk factors

A

age - risk increases
sex - higher in males
race - higher in african americans
previous stroke

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37
Q

modifiable or controllable risk factors

A 
hypertension
atrial fibrillation
cardiac disease
diabetes mellitus
elevated cholesterol
smoking
sedentary lifestyle
obesity
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38
Q

warning signs of stroke

A 
sudden numbness or weakness
sudden confusion, trouble speaking
sudden vision issues
sudden trouble walking, dizziness, or loss or balance
sudden headache
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39
Q

symptoms of a stroke

A

weakness/numbness of one side indicate disease on the contralateral carotid

ocular symptoms indicate disease on the same side - ipsilateral

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40
Q

signs of a stroke

A

smile
talk
raise both arms
stick out the tongue

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41
Q

asymptomatic symptoms of a stroke

A

risk factor

bruit

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42
Q

symptoms of a stroke:

what is…

amaurosis fugax
hemiparesis
dysarthria
aphasia
dysphagia
ataxia
diplopia
vertigo
A 
amaurosis fugax - transient vision loss
hemiparesis - paralysis
dysarthria - speech difficulty
aphasia - inability to communicate
dysphagia - difficulty swallowing
ataxia - gait disturbances
diplopia - double vision
vertigo - sensation of moving objects
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43
Q

aortic flow goes —–>

A

ascending aorta –> arch –> descending aorta

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44
Q

ascending aorta comes from _____

A

left ventricle

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45
Q

what are the 3 main arteries on the aortic arch

A

brachiocephalic or innominate artery
left CCA
left subclavian artery

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46
Q

the brachiocephalic artery divides into what 2 arteries

A

right CCA and right subclavian

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47
Q

brachiocephalic artery (right CCA & subclavian) gives rise to the right _____

A

right vertebral

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48
Q

left CCA originates to the left of the _____ artery

A

innominate or brachiocephalic

49
Q

left CCA is usually _____ than the right CCA

A

longer

50
Q

left subclavian artery gives rise to the _____

A

vertebral

51
Q

aortic arch variants:

left CCA forming a _____ origin with the innominate artery
left vertebral artery arising from the _____
right subclavian artery arises from the arch _____ to the left
left innominate _____ ____

A

common

arch

distal

may exist

52
Q

in the neck, the _____ artery, _____ vein, and _____ nerve are enclosed in connective tissue called a ______ _____

A

carotid artery
jugular vein
vagus nerve

carotid sheath

53
Q

CCA is located _____ to the trachea and the thyroid gland

A

lateral

54
Q

CCA is…

\_\_\_\_\_ in the neck
\_\_\_\_\_ to the jugular vein
\_\_\_\_\_ mm in diameter
\_\_\_\_\_ longer than right
connective tissue - \_\_\_\_\_\_ \_\_\_\_\_\_
\_\_\_\_\_\_ \_\_\_\_\_\_ lies between the artery and vein
usually \_\_\_\_\_ branches
A 
anterolaterally
medial
6-8
left
carotid sheath
vagus nerve
no
55
Q

CCA terminates at the ______ of the ___ and ___

A

bifurcation of the ICA and ECA

56
Q

Spectral analysis is performed by the _______ _____

A

computerized FFT

57
Q

ECA originates at the ___ ____ ____, usually the _____ branch, and has a ____ resistance waveform

A

mid cervical level
smaller branch
high resistance

58
Q

identifying characteristics of the ECA

A 
smaller than ICA in diameter
usually anteriomedial vessel
has no bulb
cervical portion has branches
high resistance flow
responses to temporal percussion (tapping above ear lightly)
59
Q

ECA has _____ branches

A

8

superior thyroid, ascending pharyngeal, lingual, facial, occipital, posterior auricular, superior temporal, internal maxillary

60
Q

_____ _____ artery is the most commonly seen branch of the ECA

A

superior thyroid artery

61
Q

____ ____ are used to signify ECA

A

temporal taps

62
Q

ECA supplies blood to the ….

A

face, scalp, tongue, and neck

63
Q

ECA runs _____ and _____ to the ICA

A

medially and anteriorly

64
Q

ICA arises from the _____ _____

A

CCA bifurcation

65
Q

ICA enters base of skull through the _____ ____

A

petrous bone

66
Q

ICA is the _____ branch of the CCA terminal branches

A

larger

67
Q

ICA supplies blood to the …

A

brain, eyes, forehead, and part of the nose

68
Q

ICA enter the cranial cavity via the _____ _____ in the temporal bone

A

carotid canal

69
Q

ICA gives off ____ branches within the neck region

A

no

70
Q

ICA bulb includes…

A

distal CCA and prox ECA and ICA

71
Q

Cervical ICA usually does not have ______

A

branches

72
Q

Area evaluated by Doppler may be tortuous, coiled, or kinked with ____ and ____

A

age and disease

73
Q

ICA passing into the skull gives off the _______ artery at the carotid siphon

A

ophthalmic

*postero-laterally in the neck

74
Q

ICA terminates at the _____ __ _____

A

circle of Willis

75
Q

ICA distributes to the ____ resistance vascular bed

A

low

76
Q

ICA vs ECA

A

ICA - lateral and posterior, no branches present in neck, low resistance waveform, no response to temporal tapping

ECA - medial and anterior, branches early in neck (superior thyroid artery), high resistance waveform, temporal tapping affects waveform

77
Q

Carotid imaging procedure

A

gray scale
color
doppler
consistent doppler angle

78
Q

4 things about duplex imaging

A

location of stenosis
extent of the plaque and patency of the distal ICA
presence of tortuosity or kinking of the vessels
plaque characteristics

79
Q

doppler must be ______ to vessel walls

A

parallel

80
Q

technical aspects of carotid imaging

A 
high frequency linear transducer
color assignment
color scale - PRF
wall filter
color box
color gain
81
Q

image the carotid in ____ ____ first before doing anything else

A

gray scale

82
Q

how can the CCA be distinguished from the jugular vein

A

vein changes with respiration

vein compresses

83
Q

_____ and _____ scale (PRF) should be adjusted throughout the exam to evaluate the changing velocity patterns

A

color and velocity scale

84
Q

make sure color and Doppler wall filter is set ____

A

low

85
Q

The US transducer is moved from _____ following the CCA to the level of the _____ _____

A

cephalad

carotid bifurcation (thyroid cartilage)

86
Q

at the bifurcation, the transducer is moved slightly ______ and _____ to image the origin of the ECA and ICA

A

anteriorly and posteriorly

87
Q

doppler signals are recorded from the ____, _____, _____ CCA

evaluate all doppler signals ______

A

prox, mid, distal

bilaterally

88
Q

ICA and ECA are individually followed distally to the angle of the _____

A

mandible

89
Q

what degree should be used to doppler at vessel

A

60 degrees or less

90
Q

using a _____ doppler angle permits comparison of repeated studies in the same individual

A

constant

91
Q

CCA doppler signal will display a ______ doppler shift throughout cardiac cycle

A

positive

92
Q

normal CCA carotid doppler appearance

A

sharp upstroke
clear doppler window
diastolic flow

93
Q

____ ____ usually includes origin of ICA

A

carotid bulb

*dilation of prox vessel produces a change in blood flow characteristics

94
Q

____ ____ ____ is a normal flow disturbance, is detected as a transient reversal of blood flow along posterior wall of the bulb

A

boundary layer separation

95
Q

sample volume for ICA should start just _____ to this area

A

distal

96
Q

ICA waveform shape is

A

smooth

97
Q

ICA - _____ color, _____ waveform, ____ resistance

A

continuous

smooth

low

98
Q

ECA demonstrates _______ pulsatile doppler signal because it supplies blood to skin and muscular bed of the scalp and face

A

more

99
Q

ECA usually has a ________ slope to peak systole and blood flow velocity to ______ in late diastole

A

faster

zero

100
Q

ECA - ______ pulsitile, ______ slope to peak, ______ resistance, color pattern ______ during diastole, ______ diameter, branch of the _______ ______ artery

A 
more
faster
high
decreases
smaller
superior thyroid
101
Q

vertebral artery is a branch of the ________ artery

A

subclavian

102
Q

segments of the vertebral artery are…

A

extravertebral
intervertebral
horizontal
intracranial

103
Q

___________ is evaluated during a carotid exam

A

extravertebral

104
Q

the vertebral artery lies ______ than the CCA

A

deeper

105
Q

how do you reliably identify the vertebral artery

A

it should be followed distally and periodic shadowing should be visualized from the transverse processes of the vertebrae

106
Q

follow the vertebral artery as far _________ as possible

A

proximally

107
Q

compare vertebral artery flow direction to CCA to confirm _______ or _______ flow

A

antegrade or retrograde

108
Q

________ color velocity scale is helpful in locating the vertebral artery

A

decreasing

109
Q

color flow pattern in vertebral artery will demonstrate ________ color throughout cardiac cycle, and the blood flow velocity is _______ resistive and ______ zero baseline throughout the cardiac cycle

A

continuous

low

above

110
Q

medical history…

A

arm pressures - difference of > 20 mmHg suggests a stenosis or occulsion of subclavian artery on the side of lower pressure

presence of bruits

111
Q

what is a subclavian steal

A

reversal of vertebral artery blood flow direction secondary to a significant obstruction prox to the origin of the vertebral artery in the ipsilateral subclavian or innominate artery

112
Q

do all stenosis in carotid arteries cause bruits

A

no

113
Q

gold standard method for ICA and ECA examination is ________ or ________

A

arteriography or magnetic resonance angiography

114
Q

technical errors when doing a carotid scan

A 
frequency too high for depth
inaccurate focal zone
incorrect angle
color gain too low
color scale too high
115
Q

what is evaluated during a carotid scan

A

peak systolic velocity
end diastolic velocity
direction of blood flow
shape of doppler spectral waveforms

116
Q

what is the most reliable way to distinguish the ICA from the ECA

A

doppler signal

117
Q

features of ICA and ECA

size
branches
orientation
doppler
temporal tap
pulsatility
diastolic
dicrotic notch
A

ECA ICA
size smaller larger
branches yes no
orientation anterior posterior
doppler high res low res
temporal tap yes no
pulsatility flickers constant
diastolic low high
dicrotic notch clear unclear

118
Q

what is systolic velocity ratio (SVR)

A

ICA / CCA

119
Q

as stenosis develops _______ becomes elevated

A

PSV

120
Q

______ is a good marker for high grade stenosis

A

EDV

121
Q

what is bruit

A

noise caused by tissue vibration that is produced by turbulance

may be identified from normal artery or the bruit may be transmitted (cardiac)

Summer 2014 - Intro to Vascular ✔️ (7 decks)

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