PVD: Cerebrovasc, Renovasc, Mesenteric Flashcards
Which gender has higher morbidity and mortality after stroke?
Female
Which race has higher incidence of stroke?
Black
When can you give TPA in stroke?
<4.5h from sxs onset
2 contraindications to TPA for stroke
If glucose < 50
If BP> 185/110
If pt is on warfarin and has stroke at what INR can you give TPA?
1.7
What is upper age limit to give TPA for stroke if within <3 hrs?
None
What is upper age limit to give TPA for stroke if within 3-4.5hr
<80
Name 4 contraindications for TPA in stroke within 3-4.5h
Age > 80
NIHSS> 25
DM w/ previous stroke
Taking warfarin
Can you give TPA for stroke if pt had seizure and is postictal?
No
Can you ever give TPA to a patient with even a remote history of ICH?
No
What is target BP in stroke pre and post TPA?
< 185/110
< 180/105
What do you combine with ASA to treat stroke?
Dipyridamole
What is a common side effect of dipyridamole (stroke lecture)
Headaches
Is there any benefit for heparin or lovenox in stroke?
No
Anatomical criteria (6) making a pt high risk for CEA
Lesion at C2 or higher, or below clavicle Prior radical neck Sx or radiation Contralateral carotid occlusion Prior ipsilateral CEA Contralateral laryngeal n. palsy Tracheostoma
Medical comorbidities that make pt high risk for CEA
Age > 80 Class III/IV CHF Class III/IV Angina, LM/2V CAD or recent MI EF<30% severe lung dz or renal dz.
What did CREST trial show for CEA vs CAS in terms of death, stroke and MI?
Death same
Stroke< CEA
MI
What was the difference in composite endpoints b/w CEA and CAS in CREST trial?
None
When can you do carotid bypass?
Never
4 reasons to look for RAS
Malignant/resistant HTN
Azotemia after ACEI/ARB
atrophic kidney or size discrepancy
Flash Pulm edema
What is a common way to test for renal artery stenosis besides duplex U/S?
Angiography or CTA
If a young girl comes with resistant HTN and you see “beads on a string” of renal arteries on MRA, what is next step?
Image carotid arteries
What two vessels does fibromuscular dysplasia effect?
Renal and carotid arteries
Out of the 5 classifications, what is the most common type of fibromuscular dysplasia?
Medial fibroplasia
What is intervention for renal arteries in fibromuscular dysplasia?
Angioplasty without stenting
If an elderly woman has abdominal pain out of oroportion to exam, what is diagnosis and imaging modality?
Acute mesenteric ischemia
Aortic angiography
If pt has chronic mesenteric ischemia, what is imaging modality?
MRA of abdomen
Two signs and sxs of chronic mesenteric ischemia
Weight loss
Post prandial pain
4 things that make penumbra worse in stroke
Fever, hypoperfusion, Sz, hyperglycemia
