URR treatment of carotid stenosis

Question 1

atherectomy

Answer 1

uses cath with rotating head and suction capabilities to break and remove it

Question 2

angioplasty

Answer 2

uses balloon tipped cath to compress the atheroma and expand vessel lumen

Question 3

endarterectomy

Answer 3

carotid is lacerated and atheroma formation is scraped for removal
-complications include:
restenosis attributed suboptimal surgical techniques
intimal flap
dissection
shelf lesion (residual hyperechoic plaque in lumen that has abrupt edge)
platelet aggregate (hypo/anechoic material adjacent to vessel wall that causes increased flow)

Question 4

most common stent material?

Answer 4

nitinol

Question 5

doppler cursor should be put through stent how?

Answer 5

“walked through” to find the location of highest velocity

Question 6

irregular contour of stent with a visible abrupt edge, turbulent at edge is associated with calcification

Answer 6

stent fracture

Question 7

wall of stent appears to protrude into vessel lumen, color shows reduced lumen size; elevated PSV may be present

Answer 7

stent deformation

Question 8

restenosis or myointimal hyperplasia

Answer 8

homogeneous material lining stent wall

Question 9

cerebral hyperperfusion or reperfusion syndrome

Answer 9

-rare but serious complication follow revascularization
-defined as major increase in ipsilateral cerebral flow that is well above metabolic demands of brain tissue
-causes hemorrhage
-presents as a triad of ipsilateral headache contralateral, contralateral neurological deficits, and seizure
-seen after endarterectomy or stent placement