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Vascular Boards > URR Carotid Disease > Flashcards

URR Carotid Disease Flashcards

1
Q

as area of vessel decreases what happens to velocity?

A

increases

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2
Q

flow changes direction as it enters and leaves stenosed portion causing what?

A

turbulence and spectral broadening

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3
Q

most common reason for underestimation is what?

A

improper sample volume location

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4
Q

what happens in the pre stenotic zone?

A

-increase resistance and RI
-flow velocity may be dampened with loss of diastolic
-short acceleration time

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5
Q

what happens in the stenotic zone?

A

-increase PSV
-increase diastolic
-decrease pressure
-spectral broadening
-highest velocity detected within stenosis or just distal

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6
Q

what happens in the post stenotic zone?

A

-turbulence
-decreased resistance
-increase diastolic

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7
Q

what happens distal to critical ICA stenosis?

A

-diastolic and systolic flow will be low velocity with blunted waveform
-slow acceleration time
-tardus parvus

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8
Q

normal waveform of CCA?

A

low resistive
-more than 30 cm/s difference in PSV between rt and lt CCA can indicate issue

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9
Q

CCA with reduced velocity, slow upstroke and holodiastolic flow means what?

A

stenosis prox

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10
Q

CCA with reduced velocity, quick upstroke and minimal diastolic flow reversal means what?

A

occlusion distal

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11
Q

CCA with elevated velocity means what?

A

tortuosity on that side or compensatory flow due to obstruction in other CCA

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12
Q

increased velocity in bilat CCAs means what?

A

-overestimated carotid stenosis
-systemic HTN
-increased cardiac output
-decreased hematocrit
-mild to moderate AO stenosis

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13
Q

decreased velocity in bilat CCAs means what?

A

-underestimated carotid stenosis
-CHF
-decreased cardiac ejection fraction\
-severe AO valve stenosis
-increased hematocrit
-polycythemia vera

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14
Q

bilat CCA with increased diastolic flow reversal can indicate what?

A

significant Ao valv regurg

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15
Q

intra AO balloon pump (IABP)

A

-have 2 systolic peaks
-1st peak = lt vent contraction
-2nd peak = balloon inflation
-EDV cannot be determined
-flow reversal commonly seen
-if possible, turn off for CCA eval

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16
Q

lt vent assist device (LVAD)

A

-have decreased velocity flow
-CCA waveforms vary due to device
-waveform cant be evaled

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17
Q

high resistance
-minimal to mild antegrade diastolic flow
-may have flow reversal at end of systole
-PSV normal <150 cm/sec

A

ECA

18
Q

ipsilat ICA occlusion can cause what to happen to ECA flow?

A

can become low resistive

19
Q

ipsilat CCA occlusion can cause what to ECA flow?

A

can cause ECA flow to reverse so it can supply flow to the ICA

20
Q

most accurate doppler predictor of the ICA stenosis is the what?

A

EDV

21
Q

nomal psv <125 cm/s and EDV < 40 cm/s
-as stenosis increases = PSV + EDV will increase

A

ICA

22
Q

highest ICA velocity is where in the vessel?

A

first 3 cm

23
Q

highest CCA velocity is where in the vessel?

A

first 3 cm

24
Q

compares the highest ICA to the distal CCA

A

systolic velocity ratio (SVR)
-higher ratios indicate stenosis
-when stenosis is present in the CCA, use highest normal CCA in the ratios

25
Q

compares highest end diastolic velocity to the end diastolic velocity in the distal CCA?

A

diastolic velocity ratio (DVR)
-higher ratios indicate stenosis
-when stenosis is present in the CCA, use highest normal CCA in the ratios

26
Q

indirect doppler criteria for significant ICA stenosis

A

-internalization of the ECA (becomes low resistive) w/ flow reversal in opthal A
-collat flow noted in TCD exam such as cross filling in anterior or posterior communicating a
-decreased blunted flow in one MCA

27
Q

critical stenosis

A

-near occlusion that should be treated
-significant stenosis that demonstrates small amount of flow through narrowed segment
-string flow sign
-flow velocity very low with decreased pulsatility
-bruit not usually present

28
Q

vertebral artery waveform

A

-low to medium velocity, low resistance
-variations in flow velocity between left and right is normal, left usually dominant
-stenosis usually occurs in prox A
-loss of diastolic flow indicates a dist occlusion

29
Q

early systolic deceleration in the vert a is a sign of what?

A

subclavian a stenosis

30
Q

subclavian artery waveform?

A

-normal high resistive
-right and left should be compared for expected similarity
-biphasic or monophasic waveform are associated with stenosis or occlusion

31
Q

ulceration of plaque

A

-very difficult to identify
-formation of a crevice within the atheroma deposit
-leads to the formation of a protruding edge of the atheroma that could be sheared off by blood flow becoming an embolism

32
Q

soft plaque has the greatest risk of what?

A

embolization
-complex and calcific plaque becomes increased in fibrous tissue and more easily adheres to vessel walls

33
Q

when an artery is occluded the risk of what drops?

A

risk of future stroke drops significantly when what?

34
Q

horizontal motion of vessel wall instead of wall pulsation and no flow indicates what?

A

carotid occlusion

35
Q

what happens to resistance prox to occlusion

A

increase
-flow velocity decreases too (thump flow, stump flow, or thud flow)

36
Q

diagnostic criteria for carotid occlusion?

A

-absent flow in dist ICA
-increase resistance, peaked waveform with absent diastolic flow or reversal prox
-decreased blunted flow in ipsilat MCA
-decreased resistance with increased diastolic flow in ipsilat ECA
-evidence of collats

37
Q

-during occlusion or stenosis, flow velocities in contralat carotid will be increased
-if also occluded on ipsilat, stenosis may be overestimated
-can look like CCA velocities, are increased on side with stenosis and diminished on side with occlusion
-the ICA/ CCA ratio indicates lower level of stenosis than velocity criteria

A

compensatory flow

38
Q

what is a carotid compression test?

A

-performed by physician only
-used to eval presence of collat formation
-compress unilat CCA for about 5 mon, if no symptoms occur, cerebral collats are present

39
Q

what are the false positives for stenosis?

A

-increased cardiac output
-vessel tortuosity
-inappropriate angle of insonation
-compensatory flow

40
Q

false negatives for occlusion?

A

-improper sample location
-low cardiac output
-stenosis at bulb
-inappropriate angle of insonation
-doppler angle > 60degrees
-incorrect placement
-collat formation

Vascular Boards (33 decks)

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